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Sample records for paediatric supracondylar fracture

  1. An inconvenient truth: treatment of displaced paediatric supracondylar humeral fractures.

    LENUS (Irish Health Repository)

    Donnelly, M

    2012-06-01

    The need for emergent management of displaced paediatric supracondylar humeral fractures is being questioned in the literature. Open reduction rates of up to 46% have been reported in the non-emergent management of these injuries. At our institution these fractures are managed as operative emergencies by senior personnel. To examine the ongoing need for this policy we reviewed our results. All patients managed over a five year period with Gartland type IIB or III paeditric supracondylar humeral fractures were identified and a comprehensive chart and radiographic review undertaken. The mean time from injury to fracture reduction and stabilization was 6.6 h. Consultants performed or supervised 90% of cases. Open reduction was necessary in 5% of cases. Complications included a perioperative nerve injury rate of 6% and a superficial pin site infection rate of 3%. This study suggests that, despite the challenge to trauma on-call rostering, the emergency management of these injuries is advantageous to patients in units of our size. Based on the data presented here we continue our practice of emergent management. We suggest that units of a similar size to our own would show a benefit from an analogous policy albeit an inconvenient truth.

  2. Near-infrared spectroscopy for detection of vascular compromise in paediatric supracondylar fractures

    International Nuclear Information System (INIS)

    Skowno, Justin J; De Lima, Jonathan; Quick, Tom J; Carpenter, Eleanor C; Gibbons, Paul J; Little, David G

    2014-01-01

    Children suffering supracondylar fractures of the humerus are at risk of vascular compromise, which is currently assessed clinically, although other modalities such as angiography, pulse oximetry, Doppler ultrasound and magnetic resonance angiography have been used. We sought to ascertain whether tissue haemoglobin oxygenation (StO 2 ) measurement could distinguish between patients with and without clinical vascular compromise following supracondylar fractures of the humerus. We prospectively observed StO 2  using near-infrared spectroscopy in 29 paediatric patients with supracondylar fractures requiring operative manipulation. The injured and uninjured volar forearm compartments were monitored immediately before and after fracture reduction. The relationship between StO 2  in the injured and uninjured limb, and the presence of pre-operative vascular compromise was assessed. Seven out of 29 children presented with vascular compromise. Patients with clinical vascular compromise had significantly lower pre-reduction StO 2  (63.5% ± 15%, mean ± standard deviation), compared to those without compromise (80.9% ± 10%). StO 2  normalized following surgery in all children with vascular compromise. These improvements in muscle StO 2  were associated, in all patients, with the clinical return of pulses and resolution of neurological symptoms if present. StO 2  monitoring can identify patients with clinical vascular compromise, can identify the return of adequate perfusion following operative correction of supracondylar fractures, and may be a useful adjunct to clinical assessment. (paper)

  3. Predictive factors determining outcomes in pulseless limb in paediatric supracondylar fractures of humerus.

    Science.gov (United States)

    Chaturvedi, Hemant; Khanna, Vikram; Bhargava, Rakesh; Vaishya, Raju

    2018-03-01

    Amongst all the complications associated with paediatric supracondylar humerus fractures, significant vascular injury is reported in only 1% cases, of which, less than 1% develop Volkmann's ischemic contracture. This study evaluates factors, like delay in presentation of the injury, limb perfusion and pulse, in determining functional outcome in a supracondylar humerus fractures with pulseless limb. Twenty-one paediatric patients with a pulseless supracondylar humerus fracture presenting from 2012 to 2014 were included. The patients were divided into 3 groups with Group A (pulse returned post-reduction, n = 13), Group B (pink pulseless hand, n = 7) and Group C (white pulseless hand, n = 1). 11 patients in group A and 4 patients in Group B presented within 6 h. of injury while the remaining patients presented after 6 h. The primary outcome was vascular status as indicated by radial pulse and perfusion, and secondary outcomes included functional parameters assessed with Mayo Elbow Performance Score and Flynn criteria. Mean peripheral SpO2 in Group A patients was higher than Group B and Group C had a non-recordable oxygen saturation. Mean capillary refill time was more in Group A than Group B whereas in Group C patient had blanching and no capillary refill was seen. Mean Mayo Elbow Performance Score of Group A patients was highest as compared to Group B and Group C. Patients presenting within 6 h. of injury had a higher mean Mayo Elbow Performance score as compared to the patients presenting after 6 h of injury. Functional outcome as measured by Flynn Criteria was excellent in 13 patients. 6 patients had a good, 2 had fair outcome. A moderate negative corrélation (R = -0.5798) was seen between the time elapsed from the injury and the Mayo Elbow Performance score. Duration to presentation since injury, limb perfusion and presence of peripheral pulses seem to be important predictive factors determining the outcomes in pulseless supracondylar fracture humerus.

  4. Fracture of supracondylar process of the humerus.

    Science.gov (United States)

    Suresh, S S

    2008-07-01

    The supracondylar process of the humerus is a rare skeletal anomaly, which is usually an incidental finding while an X-ray is done for some other purpose. The process can fracture resulting in pain and tender mobile swelling over the medial aspect of the arm, and consequent neurovascular symptoms, or entrapment neuropathies. The anomaly, which fractured in a clinical situation, is described, followed by a review of the literature.

  5. Fracture of Supracondylar Process of the Humerus

    OpenAIRE

    Suresh, S S

    2008-01-01

    The supracondylar process of the humerus is a rare skeletal anomaly, which is usually an incidental finding while an X-ray is done for some other purpose. The process can fracture resulting in pain and tender mobile swelling over the medial aspect of the arm, and consequent neurovascular symptoms, or entrapment neuropathies. The anomaly, which fractured in a clinical situation, is described, followed by a review of the literature.

  6. SUPRACONDYLAR FRACTURE OF THE HUMERUS IN CHILDREN

    Directory of Open Access Journals (Sweden)

    Nikola Bojović

    2012-09-01

    Full Text Available Humeral supracondylar fractures are the second most common fractures seen in children and young teenagers (16.6%. They represent 60-70% of all the elbow fractures. The maximum incidence is found between the fifth and seventh year of age, slightly more often in boys and on non-dominant hand. We performed a retrospective study in our clinic which included 105 patients admitted to our facility during the period from January, 2008 to April, 2012. The included patients had humeral supracondylar fracture either type 2 or type 3 (Gartland classification. At the moment of admission the median age was 7.26 years. All the patients were treated during the first 12 hours, with no more than two attempts of closed reposition. Sixteen patients with type 2 fracture were treated by analgosedation, closed reduction followed by cast immobilization. All other patients were treated after induction of general anesthesia. Sixteen patients were treated by percutaneous fixation of the fragments after closed reduction and 73 were treated with open reduction and pinning with different number and positions of „К“ wires. None of the patients had deep tissue infection; four patients had pin site infection. Three patients had cubitus varus deformity, two patients had elbow contracture, five patients had temporary limitation in extension, and one patient had iatrogenic lesion of the ulnar nerve. This makes 14.2% complication rate in our series. All the fractures healed in the expected period (3–4 weeks. Bauman’s angle, carrying angle and functional factor were measured postoperatively. Closed reposition with pinning, using radiographic control, for the dislocated supracondylar humeral fractures is the safest, as well as the least time consuming and cost-effective method. We also suggest treating these fractures within 12 hours and conversion of closed into open reposition in case of lacking crepitations (possibility of interposition of soft tissues between fragments.

  7. Emergency or Delayed Surgical Treatment of Unstable Supracondylar Humeral Fractures in Children?

    Directory of Open Access Journals (Sweden)

    Stefanovic Branko

    2017-06-01

    Full Text Available Supracondylar humeral fractures (SCHF are the most common elbow fractures in children, representing 3% of all paediatric fractures. Treatment options for SCHF in children are based on the Gartland classification. Treatment of non-displaced fractures (type I is non-operative. Plaster immobilization for 3 to 4 weeks is recommended, depending on the age of the child and fracture healing. Treatments of displaced supracondylar fractures (type II and III of the humerus in children are still undefined in clinical practice. Because of divided opinions, the aim of this study was to evaluate whether delayed or immediate surgical treatment has an advantage in the treatment of supracondylar fractures in children. This is a prospective – retrospective clinical study. This study included 64 patients from 5 to 15 years old; 47 (73.4% were boys and 17 (26.6% were girls. The most common age range (59.4% in this study was 5-8 years old. All patients were diagnosed with supracondylar fractures at the Institute for Orthopaedic Surgery “Banjica”. We analysed 17 parameters, which were obtained either from direct patient interviews or from their medical history. All patients were divided into two groups with matched characteristics. Group I consisted of 26 patients who had immediate operations. Group II consisted of 38 patients who had delayed operations.

  8. Medial supracondylar stress fracture in an adolescent pitcher

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Eric Y.; Chung, Christine B. [VA San Diego Healthcare System, San Diego, CA (United States); University of California, San Diego Medical Center, San Diego, CA (United States); Fronek, Jan [Scripps Healthcare, La Jolla, CA (United States)

    2014-01-15

    We report the occurrence of a medial supracondylar stress fracture in an adolescent pitcher. To our knowledge, this fracture has not been described in the literature, and awareness of this entity allows initiation of therapy and precludes further unnecessary work-up. The radiographic, computed tomography, and magnetic resonance imaging appearances are reviewed and the mechanism of injury is discussed. (orig.)

  9. SUPRACONDYLAR FRACTURE FEMUR T REATED WITH INTRAMEDULLARY NAIL : A PROSPECTIVE STUDY

    OpenAIRE

    Venkateswara Rao; Chaitanya; Anvesh

    2015-01-01

    BACKGROUND: Supracondylar fractures are one of the commonest fractures encountered in high velocity trauma which are associated with high morbidity and mortality . 1 Isolated fracture can itself lead to complications such as ARDS and pulmonary embo lism 1 . This necessitates early stabilization of fractures. Internal fixation is the choice of treatment in supracondylar fractures (AO type – A) . 2 Retrograde supracondylar nail has shown to giv...

  10. Avascular Necrosis of Trochlea After Supracondylar Humerus Fractures in Children.

    Science.gov (United States)

    Etier, Brian E; Doyle, J Scott; Gilbert, Shawn R

    2015-10-01

    Avascular necrosis (AVN) is a rare but important complication after supracondylar humerus fractures. Posttraumatic humerus deformity was first reported in 1948 and sporadically thereafter. AVN deformity has been classified as type A (AVN of the lateral ossification center) and type B (AVN of the entire medial crista and a metaphyseal portion). In this article, we present 5 cases of AVN after supracondylar humerus fracture, discuss the importance of late clinical findings, and postulate a mechanism of AVN in nondisplaced fractures. Five cases of AVN after supracondylar humerus fracture were reviewed from the Children's of Alabama database. Four of the 5 patients were female. Four patients sustained a Gartland type III fracture, and 1 patient sustained a nondisplaced Gartland type I fracture. Age at time of injury ranged from 5 years to 10 years. All patients had an asymptomatic clinical period after treatment and re-presented 6 months to 7 years later with elbow pain or loss of motion. All patients were treated symptomatically. AVN of the trochlea has a late clinical presentation. The cause of this complication is interruption of the trochlea blood supply. In displaced fractures, the medial and/or lateral vessels are injured, leading to type A or type B deformity. In nondisplaced fractures, the lateral vessels are interrupted by tamponade because of encased fracture hematoma; this presents as a type A deformity. Both type A and type B deformities can be clinically significant. AVN of the trochlea should be considered in patients with late presentation of pain or loss of motion after treatment of supracondylar humerus fractures.

  11. Bilateral femoral supracondylar stress fractures in a cross country runner.

    Science.gov (United States)

    Ross, Kate; Fahey, Mark

    2008-08-01

    Several high-risk factors lead to stress fractures. They include excessive training in athletes leading to overuse injuries, nutritional deficiencies, and endocrine disorders. While stress fractures are common, bilateral stress fractures are rarely seen. Few cases have been reported of bilateral femoral stress fractures in young athletes. This article presents a case of a 14-year-old cross country runner with a bilateral femoral supracondylar stress fracture. He presented with bilateral supracondylar stress fractures from running. The patient followed a strict vegan diet, but his parents stated that, to their knowledge, he was getting adequate protein and calcium. Treatment consisted of decreased activity to pain-free levels with acetaminophen for pain. Low-impact conditioning such as swimming and bicycling was allowed. Hamstring and quadricep stretching was suggested. Nutritional consultation was obtained to ensure appropriate nutrition on a vegan diet. At 1-month follow-up, he was pain free and allowed to proceed with a gradual return to running activities. In this case, the onset of a new workout routine was intolerable for this patient's low bone density, causing insufficiency fractures. Appropriate vegan diets were not associated with stress fracture in our literature review. He may have had an inadequate diet prior to this injury. As in this case, full recovery can be made after this rest period, and the patient may return to his or her original activity safely. In young athletes, diet and nutrition must be kept in mind.

  12. A distal femoral supra-condylar plate: biomechanical comparison with condylar plate and first clinical application for treatment of supracondylar fracture.

    Science.gov (United States)

    Liang, Bowei; Ding, Zhenqi; Shen, Junguo; Zhai, Wenliang; Kang, Liangqi; Zhou, Liang; Sha, Mo; Liang, Dongzhu

    2012-08-01

    An anatomical supra-condylar plate is designed and analysed by biomechanical testing. The biomechanical properties of the supra-condylar and condylar plate were compared in six matched pairs of cadaveric femurs. A transverse osteotomy gap was created to simulate an OTA/AO type A3 supracondylar fracture. The left and right specimens were fitted with supra-condylar and condylar plate, respectively. Nondestructive axial compression, three-point bending and torsion tests were performed, and the peak load of the bone-implant construction was measured. The fracture site suitable for supra-condylar plate application and its correlation with femoral length were calculated. The gender influence on it was also discussed. The difference of stiffness between the supra-condylar and condyle groups were not significant (P > 0.05) at 363.4 and 362.5 N/mm for compression, 229.5 and 237.6 N/mm in the sagittal plane and 195.5 and 188.4 N/mm in the coronal plane for three-point bending, and 7.5 and 7.9 Nm/deg for axial torsion, respectively. The peak load was 4438 ± 136.15 N and 5215 ± 174.33 N, respectively, for the two groups. The average extent of the fracture site suitable for the application of the supra-condylar plate was 70.86 ± 4.61 mm. The femoral length and gender showed no influence on it. Despite the limited bone contact area provided by the supra-condylar plate, its construct stiffness is comparable to the condylar plate. The supra-condylar plate can be used to treat carefully-selected extra-articular supracondylar fractures.

  13. Surgical treatment of supracondylar humerus fractures in children

    DEFF Research Database (Denmark)

    Reising, K; Schmal, H; Kohr, M

    2011-01-01

    received physiotherapy during the course of treatment. Slight varization was found in 11% of children and an unsatisfactory range of motion in 13%. Satisfactory outcomes were recorded for 83% of patients. CONCLUSION: K-wire osteosynthesis is associated with a low complication rate and continues......PURPOSE OF THE STUDY: Surgical techniques for the treatment of supracondylar fractures in children are repeatedly the subject of discussion. The aim of the present study was to compare experience with the technique of crossed Kirschner wires at our own hospital with current literature. PATIENTS...... AND METHODS: In the period from 2000-2006 a total of 86 children aged 1.7 to 12.7 years were treated by means of crossed K-wire osteosynthesis. Follow up was conducted at an average of 32 months. Outcomes were evaluated based on von Laer's criteria. RESULTS: Reported complications were migration of the K...

  14. Paediatric talus fracture.

    LENUS (Irish Health Repository)

    Byrne, Ann-Maria

    2012-01-01

    Paediatric talus fractures are rare injuries resulting from axial loading of the talus against the anterior tibia with the foot in dorsiflexion. Skeletally immature bone is less brittle, with higher elastic resistance than adult bone, thus the paediatric talus can sustain higher forces before fractures occur. However, displaced paediatric talus fractures and those associated with high-energy trauma have been associated with complications including avascular necrosis, arthrosis, delayed union, neurapraxia and the need for revision surgery. The authors present the rare case of a talar neck fracture in a skeletally immature young girl, initially missed on radiological review. However, clinical suspicion on the part of the emergency physician, repeat examination and further radiographic imaging revealed this rare paediatric injury.

  15. [Vascular and neurological complications of supracondylar humeral fractures in children].

    Science.gov (United States)

    Masár, J

    2007-10-01

    The author reports two cases of pediatric patients with supracondylar humeral fractures complicated by concomitant vascular injury. One of the patients also presented with neurological symptoms from compression of the ulnar and median nerves. In the case of vascular injury only, it was necessary to resect a 1-cm segment of the brachial artery which was thrombosed due to intimal disruption. In the other case, surgery was not indicated immediately; however, liberation of the nervus ulnaris and nervus medianus was later required because of nerve compression by the scar and bone. The author considers the exact diagnosis, precise reduction and stable fixation of a fracture to be most important for a good outcome of treatment. Any associated vascular injury is indicated for surgery only after a thorough diagnostic consideration, and may not be needed in every case. The most decisive factor is the clinical presentation. Injury to the nerve system is indicated for surgical treatment at a later period, at 3 months post-injury at the earliest.

  16. Complications after pinning of supracondylar distal humerus fractures.

    Science.gov (United States)

    Bashyal, Ravi K; Chu, Jennifer Y; Schoenecker, Perry L; Dobbs, Matthew B; Luhmann, Scott J; Gordon, J Eric

    2009-01-01

    Supracondylar distal humerus fractures are one of the most common skeletal injuries in children. The current treatment of choice in North America is closed reduction and percutaneous pin fixation. Often surgeons leave the pins exposed beneath a cast but outside the skin. Great variation exists with respect to preoperative skin preparation, and perioperative antibiotic administration. Few data exist regarding the rate of infection and other complications. The purpose of this study is to review a large series of children to evaluate the rate of infection and other complications. A retrospective review was carried out of all patients treated at our institution over an 11-year period. A total of 622 patients were identified that were followed for a minimum of 2 weeks after pin removal. Seventeen patients had flexion-type fractures, 294 had type II fractures, and 311 had type III fractures. Seventy-four fractures (11.9%) had preoperative nerve deficits with anterior interosseous palsies being the most common (33 fractures, 5.3%). Preoperative antibiotics were given to 163 patients (26.2%). Spray and towel draping were used in 362 patients, paint and towel draping were used in 65 patients, alcohol paint and towel draping were used in 146 patients, and a full preparation and draping were used in 13 patients. The pins were left exposed under the cast in 591 fractures (95%), and buried beneath the skin in 31 fractures (5.0%). A medial pin was placed in 311 fractures with a small incision made to aid placement in 18 of these cases. The most common complication was pin migration necessitating unexpected return to the operating room for pin removal in 11 patients (1.8%). One patient developed a deep infection with septic arthritis and osteomyelitis (0.2%). Five additional patients had superficial skin infections and were treated with oral antibiotics for a total infection rate of 6 of 622 patients (1.0%). One patient ultimately had a malunion and 4 others returned to the

  17. A PROSPECTIVE STUDY OF SUPRACONDYLAR FRACTURES OF THE HUMERUS IN CHILDREN TREATED BY CLOSED REDUCTION

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    Ch. Imobi

    2015-08-01

    Full Text Available There is no universal agreement regarding the management of displaced supracondylar fracture of the humerous in children. According to some orthopaedic surgeon almost all supracondylar humeral fractures should be treated operatively by reduction and pinning. While according to others closed reduction and pinning should be used for Gartland type II and some type III fractures. We present 50 cases of displaced supracondylar fracture treated by closed manipulative reduction under G.A. and immobilization with a posterior plaster of paris slab and collar and cuff. OBJECTIVE : T o assess the functional results of the injured elbow and to study the incidence of change in the carrying angle of the elbow. MATERIALS AND METHODS: This prospective study was conducted in 50 patients with extension type of displaced supracondylar fractures of humerus in children (Gartland type II and type III treated by closed manipulative reduction and immobilization in flexion of the elbow with a posterior plaster of paris slab and collar and cuff. Patients were followed up for 6 months. Flexion type of supracondylar fracture and those fractures which are absolutely indicated for operative intervention, Viz an open fracture and severe vascular compromise were excluded from the study. The range of movement and carrying angle was measured with the help of a Goniometer and Flynn criteria were used for functional assessment. RESULTS: At the end of follow up period, the end results were graded as excellent in 40%, good in 42%, fair in 12% and poor in 6%. A satisfactory result was therefore obtained in 94% and unsatisfactory result in 6% of the 50 patients who were followed and evaluated. CONCLUSION: This closed method of treatment for all practical proposes produces least complications, shorter hospital stay, can be expected to yield reproducible consistent satisfactory results not surpassed by any other method of treatment.

  18. OUTCOME OF GARTLAND TYPE – II SUPRACONDYLAR FRACTURES OF HUMERUS TREATED BY CONSERVATIVE METHOD

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    Dinesh Mitra

    2015-08-01

    Full Text Available BACKGROUND: The current literatures recommend operative method (closed reduction and pinning for type II supracondylar fractures of humerus. But some surgeons still prefer conservative method for type II supracondylar fractures of humerus. We pr esent results of 14 cases of type II supracondylar fractures treated with CR and AE POP immobilization . The purpose of this study is to evaluate the outcome of conservative treatment in management of type II supracondylar fracture of humerus. MATERIALS AND METHODS: Fourteen children treated by conservative methods (CR & AE POP between January 2013 and December 2014 is included in this study. The mean age group is 6.8 years (3 years - 11 years. The patient follow up is done for a minimum of 10 - 12 weeks. Treatment outcome is based on final clinical and radiological assessments and grading of results was done using Flynn’s criteria. RESULTS: Gartland type II fracture gives 82% excellent results and 28 % good results as per Flynn’s criteria. Of the 14 patien ts only two cases required re manipulation. Surgical intervention was not needed for any of the patients. No patients in this study developed compartment syndrome / cubitus varus deformity. CONCLUSION: Satisfactory results can be obtained with conservative treatment (closed reduction and above elbow POP if proper selection of the patient and careful clinical and radiological follow up is done

  19. Dorgan's lateral cross-wiring of supracondylar fractures of the humerus in children: A retrospective review.

    LENUS (Irish Health Repository)

    Queally, Joseph M

    2010-06-01

    The currently accepted treatment for displaced supracondylar humeral fractures in children is closed reduction and fixation with percutaneous Kirschner wires. The purpose of this study was to retrospectively review a novel cross-wiring technique where the cross-wire configuration is achieved solely from the lateral side, thereby reducing the risk of ulnar nerve injury.

  20. Utility of Postoperative Antibiotics After Percutaneous Pinning of Pediatric Supracondylar Humerus Fractures.

    Science.gov (United States)

    Schroeder, Nicholas O; Seeley, Mark A; Hariharan, Arun; Farley, Frances A; Caird, Michelle S; Li, Ying

    2017-09-01

    Pediatric supracondylar humerus fractures are common injuries that are often treated surgically with closed reduction and percutaneous pinning. Although surgical-site infections are rare, postoperative antibiotics are frequently administered without evidence or guidelines for their use. With the increasing prevalence of antibiotic-resistant organisms and heightened focus on health care costs, appropriate and evidence-based use of antibiotics is needed. We hypothesized that postoperative antibiotic administration would not decrease the rate of surgical-site infection. A billing query identified 951 patients with operatively treated supracondylar humerus fractures at our institution over a 15-year period. Records were reviewed for demographic data, perioperative antibiotic use, and the presence of surgical-site infection. Exclusion criteria were open fractures, open reduction, pathologic fractures, metabolic bone disease, the presence of other injuries that required operative treatment, and follow-up <2 weeks after pin removal. χ and Fisher exact test were used to compare antibiotic use to the incidence of surgical-site infection. Six hundred eighteen patients met our inclusion criteria. Two hundred thirty-eight patients (38.5%) received postoperative antibiotics. Eleven surgical-site infections were identified for an overall rate of 1.8%. The use of postoperative antibiotics was not associated with a lower rate of surgical-site infection (P=0.883). Patients with a type III fracture (P<0.001), diminished preoperative vascular (P=0.001) and neurological status (P=0.019), and postoperative hospital admission (P<0.001) were significantly more likely to receive postoperative antibiotics. Administration of postoperative antibiotics after closed reduction and percutaneous pinning of pediatric supracondylar humerus fractures does not decrease the rate of surgical-site infection. Level III-therapeutic.

  1. ULNAR NEURITIS ASSOCIATED WITH GUN STOCK DEFORMITY FOLLOWING SUPRACONDYLAR FRACTURE OF HUMERUS

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    Sunita Morhan

    2014-04-01

    Full Text Available Background: This case report describes a patient who was referred to physiotherapist from a hand surgeon. Among the fractures around the elbow joint, radial head fracture and fracture of distal end of radius are common among adults. The occurrence of Supracondylar fractures are more commonly seen in children when compared to adults. One of the complications of this fracture is malunion resulting in Gun stock deformity. The main Purpose of this case report is to explore, 1. The complication associated with gunstock deformity 2. Chances of iatrogenic nerve injury after manipulation under anesthesia. 3.Long term supervised rehabilitation approach. Case Description: A 40 years old male patient referred to our Physiotherapy department by a hand surgeon. After the initial evaluation, findings revealed limitation in right elbow movement and tingling and numbness sensation in little and half of ring fingers in his right side. This patient underwent ulnar nerve transposition surgery followed by rehabilitation. His physiotherapy session includes electrotherapeutic agents for pain relief, passive mobilization of elbow and strengthening program for his flexors and extensors of elbow for a period of one year. Outcome: The outcome of the long term rehabilitation approach for a patient with ulnar neuropathy secondary to gunstock deformity after ulnar nerve transposition surgery is good. The patients tingling and numbness decreased and the range of elbow movement improved significantly. Discussion: Most common complications of fracture of distal end of humerus include malunion,ischemic contracture and nerve injuries. The relative incidence of iatrogenic nerve injuries associatedwith this fracture has been reported as being 2%-6%. Nerve injuries after Supracondylar humeral fractures occur primarily due to tenting or entrapment of the nerve on the sharp proximal humeral fragment, while iatrogenic injuries occur either during closed manipulation or percutaneous

  2. Supracondylar fracture in children. Rehabilitation in occupational therapy. Yes or no?

    Science.gov (United States)

    Costa, Maria J.; Pires, Mafalda; Neves, Cassiano; Tavares, Delfin; Quintas, Alexandra M.; Ferreira, Ana I.; Espirito Santo, M. J.; Castro, Alexandra; Cabral, M. Salomé; João Gomes, J. F.

    2013-10-01

    The aim of this study was to evaluate the recovery time of elbow range of motion after treatment of Gartland's type II and III supracondylar fractures of distal humerus in children who attended a program of occupational therapy (OT). A randomized control design (RCD) was conducted to compare the two groups (OT group and Control group) and several statistical methodologies have been used to compare them. In all the cases the results point out to a faster recover in the OT group. All the analysis were performed using the package R version 3.0.1.

  3. Pulseless supracondylar humeral fractures in children: vascular complications in a ten year series.

    Science.gov (United States)

    Cambon-Binder, Adeline; Jehanno, Pascal; Tribout, Laurent; Valenti, Philippe; Simon, Anne-Laure; Ilharreborde, Brice; Mazda, Keyvan

    2018-04-01

    The management of pulseless supracondylar fractures remains controversial. The aims of this study were to: (1) analyse functional and vascular outcomes of conservative treatment for cases with absent pulse before reduction, whether patients showed limb ischaemia or not; and (2) identify factors associated with vascular complications. Twenty-seven children with absent pulses on presentation were treated consecutively between 1999 and 2009. The brachial artery was surgically explored in cases of persistent signs of ischaemia after reduction. Signs of vascular impairment were recorded in the early post-operative period and at a mean final follow-up of 3.5 years. Recurrent ischaemia with a compartment syndrome occurred in a patient with initial ischaemia and a pink, pulseless hand after reduction. Patients with an initially well-perfused hand and those with pre-operative ischaemia and palpable pulses after reduction had satisfactory outcomes, as did patients with early arterial exploration. No patient showed signs of chronic vascular impairment. The need for vascular repair was significantly correlated with open fracture, initial ischaemia and nerve impairment. Conservative management of supracondylar fractures with absent pulses avoided long-term vascular complications provided that patients with a pulseless, well-perfused hand on presentation were closely monitored after reduction. Further study is necessary to determine whether a forearm Doppler would help identify children with absent pulses after reduction who need surgical revascularisation due to an insufficient collateral circulation.

  4. The Role of Nerve Exploration in Supracondylar Humerus Fracture in Children with Nerve Injury

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    Anuar RIM

    2015-11-01

    Full Text Available The supracondylar humerus fracture (SCHF in children is common and can be complicated with nerve injury either primarily immediate post-trauma or secondarily posttreatment. The concept of neurapraxic nerve injury makes most surgeons choose to ‘watch and see’ the nerve recovery before deciding second surgery if the nerve does not recover. We report three cases of nerve injury in SCHF, all of which underwent nerve exploration for different reasons. Early reduction in the Casualty is important to release the nerve tension before transferring the patient to the operation room. If close reduction fails, we proceed to explore the nerve together with open reduction of the fracture. In iatrogenic nerve injury, we recommend nerve exploration to determine the surgical procedure that is causing the injury. Primary nerve exploration will allow early assessment of the injured nerve and minimize subsequent surgery.

  5. Extraarticular bony ankylosis in a child with supracondylar fracture of humerus

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    Naranje Sameer

    2012-11-01

    Full Text Available 【Abstract】 Myositis ossificans is defined as forma-tion of bone at the site of injured muscle. It is one of the rare complications of supracondylar fracture of humerus in children. Myositis mass usually develops on the anterior aspect in the brachialis muscle and produces restriction of range of motion, but complete ankylosis is rare. To the best of our knowledge, this is the first case to be reported in the literature as a consequence of myositis ossificans traumatica. In this case, a six-year-old child presented to the casualty department with pain in the right elbow after a fall on out-stretched hand during play. After surgical excision through the anterior approach, the child had no symptoms referable to the elbow and a residual flexion deformity of 15 degrees with further painless flexion up to 100 degrees at last follow-up of one year after surgery. Key words: Humerus; Fractures, Bone; Myositis; Ankylosis

  6. Multicenter Study of Pin Site Infections and Skin Complications Following Pinning of Pediatric Supracondylar Humerus Fractures.

    Science.gov (United States)

    Combs, Kristen; Frick, Steven; Kiebzak, Gary

    2016-12-03

    Pediatric supracondylar humerus fractures are the most common elbow fractures in pediatric patients. Surgical fixation using pins is the primary treatment for displaced fractures. Pin site infections may follow supracondylar humerus fracture fixation; the previously reported incidence rate in the literature is 2.34%, but there is significant variability in reported incidence rates of pin site infection. This study aims to define the incidence rate and determine pre-, peri-, and postoperative factors that may contribute to pin site infection following operative reduction, pinning, and casting. A retrospective chart analysis was performed over a one-year period on patients that developed pin site infection. A cast care form was added to Nemours' electronic medical records (EMR) system (Epic Systems Corp., Verona, WI) to identify pin site infections for retrospective review. The cast care form noted any inflamed or infected pins. Patients with inflamed or infected pin sites underwent a detailed chart review. Preoperative antibiotic use, number and size of pins used, method of postoperative immobilization, pin dressings, whether postoperative immobilization was changed prior to pin removal, and length of time pins were in place was recorded. A total of 369 patients underwent operative reduction, pinning, and casting. Three patients developed a pin site infection. The pin site infection incidence rate was 3/369=0.81%. Descriptive statistics were reported for the three patients that developed pin site infections and three patients that developed pin site complications. Pin site infection development is low. Factors that may contribute to the development of pin site infection include preoperative antibiotic use, length of time pins are left in, and changing the cast prior to pin removal.

  7. Early Vessels Exploration of Pink Pulseless Hand in Gartland III Supracondylar Fracture Humerus in Children: Facts and Controversies

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    Tunku-Naziha TZ

    2017-03-01

    Full Text Available The management of pink pulseless limbs in supracondylar fractures has remained controversial, especially with regards to the indication for exploration in a clinically well-perfused hand. We reviewed a series of seven patients who underwent surgical exploration of the brachial artery following supracondylar fracture. All patients had a non-palpable radial artery, which was confirmed by Doppler ultrasound. CT angiography revealed complete blockage of the artery with good collateral and distal run-off. Two patients were more complicated with peripheral nerve injuries, one median nerve and one ulnar nerve. Only one patient had persistent arterial constriction which required reverse saphenous graft. The brachial arteries were found to be compressed by fracture fragments, but were in continuity. The vessels were patent after the release of obstruction and the stabilization of the fracture. There was no transection of major nerves. The radial pulse was persistently present after 12 weeks, and the nerve activity returned to full function.

  8. A comparison of more and less aggressive bone debridement protocols for the treatment of open supracondylar femur fractures.

    Science.gov (United States)

    Ricci, William M; Collinge, Cory; Streubel, Philipp N; McAndrew, Christopher M; Gardner, Michael J

    2013-12-01

    This study compared results of aggressive and nonaggressive debridement protocols for the treatment of high-energy, open supracondylar femur fractures after the primary procedure, with respect to the requirement for secondary bone grafting procedures, and deep infection. Retrospective review. Level I and level II trauma centers. Twenty-nine consecutive patients with high-grade, open (Gustilo types II and III) supracondylar femur fractures (OTA/AO 33A and C) treated with debridement and locked plating. Surgeons at 2 different level I trauma centers had different debridement protocols for open supracondylar femur fractures. One center used a more aggressive (MA) protocol in their patients (n = 17) that included removal of all devitalized bone and placement of antibiotic cement spacers to fill large segmental defects. The other center used a less aggressive (LA) protocol in their patients (n = 12) that included debridement of grossly contaminated bone with retention of other bone fragments and no use of antibiotic cement spacers. All other aspects of the treatment protocol at the 2 centers were similar: definitive fixation with locked plates in all cases, IV antibiotics were used until definitive wound closure, and weight bearing was advanced upon clinical and radiographic evidence of fracture healing. Healing after the primary procedure, requirement for secondary bone grafting procedures, and the presence of deep infection. Demographics were similar between included patients at each center with regard to age, gender, rate of open fractures, open fracture classification, mechanism, and smoking (P > 0.05). Patients at the MA center were more often diabetic (P debridement (35% vs. 0%, P debridement (71% vs. 8%, P debridement (92% vs. 35%, P debrided after a high-energy, high-grade, open supracondylar femur fracture is a matter of surgeon judgment and falls along a continuous spectrum. Based on the results of the current study, the theoretic trade-off between infection

  9. Close reduction and per cutaneous pinning of supracondylar fractures of humerus in children

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    Iqbal, S.; Maqbool, N.

    2014-01-01

    The purpose of this study was to assess outcome and complications associated with closed reduction and internal fixation of supracondylar fractures type III of humerus in children. Study Design: Quasi - experimental. Place and Duration of Study: Department of Orthopedics, Fauji Foundation Hospital Rawalpindi and Railway General Hospital (RGH), Rawalpindi, from June 2011 to August 2012. Material and Method: The study group included 16 boys and 8 girls aged 4-12 years with supracondyle Type III fractures of humerus, having no neurovascular injury and no appreciable edema. Relevant history and clinical details were taken. All those cases having any neurovascular injury or moderate to severe edema at elbow and presenting late more than two weeks were excluded. These cases were treated with closed reduction and internal fixation. Follow up was done for 6 months to assess the level of cosmetic and function according to the system described by Flynn's et al as excellent, good, fair and poor. Results: Study was completed on 24 patients (16 males and 8 females). All fractures were united in acceptable alignment. At final assessment there were 16 excellent, 5 good, 3 fair. No one was poor. The fair clinical outcome was higher in children above 10 years of age. Conclusion: Closed reduction and internal fixation with cast stabilization can provide precise and good fracture reduction, maintains stabilization for fracture healing, results in good cosmetic outcome, cost effective and facilitates easy removal of implants after treatment. (author)

  10. Comparison between a multicentre, collaborative, closed-loop audit assessing management of supracondylar fractures and the British Orthopaedic Association Standard for Trauma 11 (BOAST 11) guidelines.

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    Goodall, R; Claireaux, H; Hill, J; Wilson, E; Monsell, F; Boast Collaborative; Tarassoli, P

    2018-03-01

    Aims Supracondylar fractures are the most frequently occurring paediatric fractures about the elbow and may be associated with a neurovascular injury. The British Orthopaedic Association Standards for Trauma 11 (BOAST 11) guidelines describe best practice for supracondylar fracture management. This study aimed to assess whether emergency departments in the United Kingdom adhere to BOAST 11 standard 1: a documented assessment, performed on presentation, must include the status of the radial pulse, digital capillary refill time, and the individual function of the radial, median (including the anterior interosseous), and ulnar nerves. Materials and Methods Stage 1: We conducted a multicentre, retrospective audit of adherence to BOAST 11 standard 1. Data were collected from eight hospitals in the United Kingdom. A total of 433 children with Gartland type 2 or 3 supracondylar fractures were eligible for inclusion. A centrally created data collection sheet was used to guide objective analysis of whether BOAST 11 standard 1 was adhered to. Stage 2: We created a quality improvement proforma for use in emergency departments. This was piloted in one of the hospitals used in the primary audit and was re-audited using equivalent methodology. In all, 102 patients presenting between January 2016 and July 2017 were eligible for inclusion in the re-audit. Results Stage 1: Of 433 patient notes audited, adherence to BOAST 11 standard 1 was between 201 (46%) and 232 (54%) for the motor and sensory function of the individual nerves specified, 318 (73%) for radial pulse, and 247 (57%) for digital capillary refill time. Stage 2: Of 102 patient notes audited, adherence to BOAST 11 standard 1 improved to between 72 (71%) and 80 (78%) for motor and sensory function of the nerves, to 84 (82%) for radial pulse, and to 82 (80%) for digital capillary refill time. Of the 102 case notes reviewed in stage 2, only 44 (43%) used the quality improvement proforma; when the proforma was used

  11. Open Reduction and Internal Fixation of displaced Supracondylar Fractures of Humerus with Crossed K-wires via Medial Approach

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    S Hussain

    2014-07-01

    Full Text Available This study aimed at evaluating the medial approach for open reduction and internal fixation of Gartland type 3 displaced supracondylar fractures of humerus in children. A prospective, single centre study of on displaced supracondylar humerus fractures in 42 children was carried out at our institute. All fractures were managed with open reduction and internal fixation with crossed K-wires via medial approach. The mean follow-up was 12 months and patients were assessed according to Flynn’s criteria. No patients had post-operative ulnar nerve injury. Cubitus varus was not seen in any patient. Superficial pin tract infection occurred in three patients that subsided with anti-septic dressings and antibiotics. No deep infection occurred. 88.09 % patients showed satisfactory results as per Flynn’s criteria. The medial approach provides an excellent view of the supracondylar area. The approach is convenient due to a lower risk for ulnar nerve injury and better acceptability of the medial incisional scar.

  12. Utility of the AAOS Appropriate Use Criteria (AUC) for Pediatric Supracondylar Humerus Fractures in Clinical Practice.

    Science.gov (United States)

    Ibrahim, Talal; Hegazy, Abdelsalam; Abulhail, Safa I S; Ghomrawi, Hassan M K

    2017-01-01

    The American Academy of Orthopaedic Surgeons (AAOS) recently developed an Appropriate Use Criteria (AUC) for pediatric supracondylar humerus fractures (PSHF). The AUC is intended to improve quality of care by informing surgeon decision making. The aim of our study was to cross-reference the management of operatively treated PSHF with the AAOS-published AUC. The AUC for PSHF include 220 patient scenarios, based on different combinations of 6 factors. For each patient scenario, 8 treatment options are evaluated as "appropriate," "maybe appropriate," and "rarely appropriate." We retrospectively reviewed the medical charts and radiographs of all operatively treated PSHF at our hospital from January 2013 to December 2014 and determined the appropriateness of the treatment. Over the study period, 94 children (mean age: 5.2 y; 51 male, 43 female) were admitted with PSHF and underwent a surgical procedure (type IIA: 7, type IIB: 14, type III: 70, flexion type: 3). Only 8 of the 220 scenarios were observed in our patient cohort. The most frequent scenario was represented by a type III fracture, palpable distal pulse, no nerve injury, closed soft-tissue envelope, no radius/ulna fracture, and typical swelling. Of the 94 fractures, the AUC was "appropriate" for 84 cases and "maybe appropriate" for 9 cases. There was only 1 case of "rarely appropriate" management. Closed reduction with lateral pinning and immobilization was the most prevalent treatment option (58.5%). The rate of appropriateness was not affected by the operating surgeon. However, the definition of a case as emergent had a significant impact on the rate of appropriateness. Application of the AUC to actual clinical data was relatively simple. The majority of operatively treated PSHF (89.4%) were managed appropriately. With the introduction of electronic medical charts, an AUC application becomes attractive and easy for orthopaedic surgeons to utilize in clinical practice. However, validity studies of the AUC in

  13. Is Closed Manipulative Reduction and Percutaneous Kirschner Wiring of Supracondylar Humeral Fracture in Children as Day-Care Surgery a Safe Procedure ?

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    Ashok R Nayak

    2013-07-01

    Full Text Available INTRODUCTION: Supracondylar fracture of the humerus is a common injury in children. It accounts for 60% of fractures around the elbow children. If the fracture is not treated properly it may give rise to many complications like malunion, Volkmann’s ischemic contracture, nerve injury, arterial injury, skin slough, heterotopic bone formation , and stiffness of elbow. The management of displaced supracondylar fracture of the elbow is one of the most difficult of the many fractures seen in children. The purpose of the study was to evaluate the anatomical and functional results of treatment of supracondylar fractures of humerus with closed reduction and percutaneous ‘K’ wire fixation as a day care procedure and record associated complications, thus decreasing the cost of treating these fractures and hospitalization. METHODS: Fifty displaced closed extension type supracondylar fractures (Gartland’s type III of the humerus in children were treated by closed reduction and percutaneous fixation with Kirschner wires. All the patients selected for this study had been treated in a day care unit and were discharged in the same evening and followed up at 3 and 6 weeks and 3 months. Open fractures, fractures with neurovascular complications and children older than 15 yrs were excluded. The final results were evaluated by Flynn’s criteria. RESULTS: The majority (72%, of the patients had fracture displaced posteomedially, Fourty one of the fifty patients had satisfactory results. The majority of the patients were male, and the average age was 8-9 years. CONCLUSION: Percutaneous fixation of supracondylar humerus done as a day care procedure is an acceptable modality of treatment and reduces the duration of hospital stay for the patient.

  14. The value of modified DASH questionnaire for evaluation of elbow function after supracondylar fractures in children

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    Čolović Hristina

    2008-01-01

    Full Text Available Background/Aim. The Disabilities of the Arm, Shoulder and Hand (DASH Outcome Questionnaire represents a region- specific instrument for functional outcome measurement of hand function. The aim of the study was to analyze the correlation between the values of modified DASH questionnaire and change of elbow function after supracondylar fracture (SCF of humerus and to analyze the effects of early rehabilitation. Methods. The study included 35 schoolaged children with flexion of SCF of humerus without lesion of nerves. The patients were divided into two groups: group A in which rehabilitation started up to 14 days after the removal of fixation (20 children, and group B in which rehabilitation started after 15 days and more (15 children. The effects of the applied rehabilitation procedures were analyzed by measuring the range of motion of elbow and using modified DASH questionnaire. Testing was performed during the first examination, on the first day of rehabilitation (retest and after the rehabilitation. Pearson's coefficient of liner correlation was applied. Results. Statistically significant negative correlation of DASH score and extension was verified in all three measurements. The values for the first test and for the final test were highly significant (p < 0.001, as well as negative correlation of DASH score and flexion on the first test and retest (p < 0.01, and at the end of rehabilitation (p < 0.001 in the group B. For all three tests in the group A negative correlation without significant differences for DASH score and flexion was found. Conclusion. A modified DASH questionnaire correlates with objective parameters of final status of elbow after SCF in children and it is applicable to small series of patients. A positive effect of early rehabilitation of children with SCF was found.

  15. Triceps-sparing approach for open reduction and internal fixation of neglected displaced supracondylar and distal humeral fractures in children.

    Science.gov (United States)

    Rizk, Ahmed Shawkat

    2015-06-01

    Supracondylar humeral fractures are one of the most common skeletal injuries in children. In cases of displacement and instability, the standard procedure is early closed reduction and percutaneous Kirschner wire fixation. However, between 10 and 20 % of patients present late. According to the literature, patients with neglected fractures are those patients who presented for treatment after 14 days of injury. The delay is either due to lack of medical facilities or social and financial constraints. The neglected cases are often closed injuries with no vascular compromise. However, the elbow may still be tense and swollen with abrasions or crusts. In neglected cases, especially after early appearance of callus, there is no place for closed reduction and percutaneous pinning. Traditionally, distal humeral fractures have been managed with surgical approaches that disrupt the extensor mechanism with less satisfactory functional outcome due to triceps weakness and elbow stiffness. The aim of this study is to evaluate the outcome of delayed open reduction using the triceps-sparing approach and Kirschner wire fixation for treatment of neglected, displaced supracondylar and distal humeral fractures in children. This prospective study included 15 children who had neglected displaced supracondylar and distal humeral fractures. All patients were completely evaluated clinically and radiologically before intervention, after surgery and during the follow-up. The follow-up period ranged from 8 to 49 months, with a mean period of 17 months. Functional outcome was evaluated according to the Mayo Elbow Performance Index (MEPI) and Mark functional criteria. All fractures united in a mean duration of 7.2 weeks (range 5-10 weeks) with no secondary displacement or mal-union. Excellent results were found at the last follow-up in 13 of the 15 patients studied (86.66 %), while good results were found in two patients (13.33 %) according to the MEPI scale. According to the Mark

  16. Surgical Interventions for the Treatment of Supracondylar Humerus Fractures in Children: Protocol of a Systematic Review.

    Science.gov (United States)

    Carrazzone, Oreste Lemos; Belloti, João Carlos; Matsunaga, Fabio Teruo; Mansur, Nacime Salomão Barbachan; Matsumoto, Marcelo Hide; Faloppa, Flavio; Tamaoki, Marcel Jun Sugawara

    2017-11-21

    The treatment of supracondylar humerus fracture in children (SHFC) is associated with complications such as functional deficit, residual deformity, and iatrogenic neurological damage. The standard treatment is closed reduction and percutaneous Kirschner wire fixation with different configurations. Despite this fact, there is still no consensus on the most effective technique for the treatment of these fractures. The aim of this systematic review will be to evaluate the effect of surgical interventions on the treatment of Gartland type II and III SHFC by assessing function, complications, and error as primary outcomes. Clinical outcomes such as range of motion and pain and radiographic outcomes will also be judged. A systematic review of randomized controlled trials or quasi-randomized controlled trials evaluating the surgical treatment of SHFC will be carried out in the Cochrane Central Register of Controlled Trials, PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde, and Excerpta Medica Database. The search will also occur at ongoing and recently completed clinical trials in selected databases. Data management and extraction will be performed using a data withdrawal form and by analyzing the following: study method characteristics, participant characteristics, intervention characteristics, results, methodological domains, and risk of bias. To assess the risk of bias of the included trials, the Cochrane Risk of Bias Tool will be used. Dichotomous outcome data will be analyzed as risk ratios, and continuous outcome data will be expressed as mean differences, both with 95% confidence intervals. Also, whenever possible, subgroup analysis, sensitivity analysis, and assessment of heterogeneity will be performed. Following the publication of this protocol, searches will be run and included studies will be deeply analyzed. We hope to obtain final results in the next few months and have the final paper published by the end of 2018. This study was funded

  17. Clinical study of emergency treatment and selective closed reduction for the treatment of supracondylar humerus fracture in children

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    Wei Zhong

    2016-11-01

    Full Text Available Objective: To study the effect of emergency treatment, selective closed reduction combined with percutaneous Kirschner wire fixation on the treatment of Gartland type-II and type-III supracondylar humerus fracture. Methods: Children who sustained the Gartland type-II and type-III supracondylar fractures of humerus treated with selective closed reduction combined with percutaneous Kirschner wire fixation in our hospital from May 2012 to August 2015 were analyzed retrospectively. They were divided into group A (emergency operation group and group B (selective operation group according to different operation timing. Perioperative situation, blood biochemical parameters, swelling degree and elbow joint function of affected limb were compared between two groups. Results: Operation time for patients of group A was significantly shorter than that of group B [(17.19 ± 2.85 vs. (21.43 ± 3.91 min], and frequency of fluoroscopy during operation of group A was obviously less than that of group B [(6.03 ± 0.95 vs. (7.61 ± 0.92 times]. Swelling index of affected limb in group A at 3 days, 5 days and 7 days after injury was all significantly lower than that in group B [(1.20 ± 0.17 vs. (1.38 ± 0.14, (1.13 ± 0.13 vs. (1.30 ± 0.18, (1.02 ± 0.15 vs. (1.22 ± 0.15]. Hospital for special surgery score at 1 week, 2 weeks, 3 and 4 weeks after removing Kirschner wire had no significant difference between group A and B (88.75 ± 10.18 vs. (89.14 ± 10.52, (94.22 ± 10.85 vs. (93.85 ± 11.08, (95.52 ± 11.27 vs. (95.92 ± 12.19, (95.43 ± 10.96 vs. (96.02 ± 11.38. Contents of serum alanine transaminase, aspertate aminotransferase, total protein, albumin and C-reactive protein in perioperative period had no obvious difference between patients in group A and B. Conclusions: Emergency closed reduction combined with percutaneous Kirschner wire fixation for Gartland type-II and type-III supracondylar humerus fracture in children has less trauma, low swelling degree

  18. Closed Versus Open Supracondylar Fractures of the Humerus in Children: A Comparison of Clinical and Radiographic Presentation and Results.

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    Lewine, Eliza; Kim, Jaehon M; Miller, Patricia E; Waters, Peter M; Mahan, Susan T; Snyder, Brian; Hedequist, Daniel; Bae, Donald S

    2018-02-01

    The purpose of this investigation was to compare the presentation and postoperative results of children treated for open and closed, completely displaced type III supracondylar humerus fractures (SCFs). Thirty patients with open and 66 patients with closed, completely displaced type III SCFs were evaluated. Open fractures underwent irrigation and debridement, and all patients were treated by open or closed reduction and pin fixation. Medical records were reviewed to obtain demographic information as well as preoperative and postoperative clinical data regarding mechanism of injury, neurovascular status, associated injuries, postoperative range of motion, infections, and pain. Radiographs were evaluated to quantify displacement, Baumann's angle, humeral capitellar angle, position of the anterior humeral line, and adequacy of reduction. Outcomes were assessed using Flynn criteria. Mean clinical follow-up for the open and closed fracture groups was 8.9 and 5.7 months, respectively. Both groups were similar with respect to age, sex distribution, weight and body mass index, laterality of involvement, and mechanism of injury. At presentation, 35% of closed SCFs and 23% of open SCFs presented with abnormal neurovascular status. There was a higher prevalence of diminished/absent pulses or distal limb ischemia in patients with open injuries (27%) compared with closed fractures (18%). Conversely, severely displaced closed fractures were more commonly associated with nerve injury/palsy at presentation (35%) than those with open fractures (23%). Spontaneous nerve recovery was seen in 87% within 3 to 6 months. Postoperative loss of reduction and malunion were more common in the closed fracture group. However, 84% of patients achieved good-to-excellent results by Flynn criteria, with no appreciable difference based upon open versus closed fractures. With timely wound and fracture treatment, the clinical and radiographic results of children treated for open SCFs is similar to

  19. Simulation-Based Educational Module Improves Intern and Medical Student Performance of Closed Reduction and Percutaneous Pinning of Pediatric Supracondylar Humeral Fractures.

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    Butler, Bennet A; Lawton, Cort D; Burgess, Jamie; Balderama, Earvin S; Barsness, Katherine A; Sarwark, John F

    2017-12-06

    Simulation-based education has been integrated into many orthopaedic residency programs to augment traditional teaching models. Here we describe the development and implementation of a combined didactic and simulation-based course for teaching medical students and interns how to properly perform a closed reduction and percutaneous pinning of a pediatric supracondylar humeral fracture. Subjects included in the study were either orthopaedic surgery interns or subinterns at our institution. Subjects all completed a combined didactic and simulation-based course on pediatric supracondylar humeral fractures. The first part of this course was an electronic (e)-learning module that the subjects could complete at home in approximately 40 minutes. The second part of the course was a 20-minute simulation-based skills learning session completed in the simulation center. Subject knowledge of closed reduction and percutaneous pinning of supracondylar humeral fractures was tested using a 30-question, multiple-choice, written test. Surgical skills were tested in the operating room or in a simulated operating room. Subject pre-intervention and post-intervention scores were compared to determine if and how much they had improved. A total of 21 subjects were tested. These subjects significantly improved their scores on both the written, multiple-choice test and skills test after completing the combined didactic and simulation module. Prior to the module, intern and subintern multiple-choice test scores were significantly worse than postgraduate year (PGY)-2 to PGY-5 resident scores (p < 0.01); after completion of the module, there was no significant difference in the multiple-choice test scores. After completing the module, there was no significant difference in skills test scores between interns and PGY-2 to PGY-5 residents. Both tests were validated using the scores obtained from PGY-2 to PGY-5 residents. Our combined didactic and simulation course significantly improved intern and

  20. Paediatric femur fractures at the emergency department: accidental or not?

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    Hoytema van Konijnenburg, Eva M. M.; Vrolijk-Bosschaart, Thekla F.; Bakx, Roel; van Rijn, Rick R.

    2016-01-01

    Only a small proportion of all paediatric fractures is caused by child abuse or neglect, especially in highly prevalent long bone fractures. It can be difficult to differentiate abusive fractures from non-abusive fractures. This article focuses on femoral fractures in young children. Based on three

  1. FUNCTIONAL OUTCOME OF SUPRACONDYLAR FRACTURES OF FEMUR MANAGED BY OPEN REDUCTION AND INTERNAL FIXATION WITH LOCKING COMPRESSION PLATE

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    Madhusudhana

    2015-10-01

    Full Text Available INTRODUCTION : Incidence of distal femur fractures is approximately 37 per 1 , 00,000 person - years.¹Distal femoral fractures has two different injury mechanisms, high energy trauma and low energy trauma. In high - energy trauma, the problem of restoring the function in a destroyed knee joint persists. Complex knee ligament injuries frequently occur additionally to extensive cartilage injuries. In elderly patients, extreme osteoporosis represents a particular problem for anchoring the implant. 2 Supracondylar and inter condylar fractures often are unstable and comminuted and tend to occur in the elderly or those with multiple injuries. Treatment options are many with varied results. The final outcome would depend upon the type of fracture, stabilization of fixation and and perhaps patient general condition. 3 The options for operative treatment are traditional plating techniques that require compression of the implant to the femoral shaft (blade plate, Dynamic Condylar Screw, non - locking condylar buttress plate, antegrade nailing fixation, retrograde nailing, sub muscular locked internal fixation and external fixation. 4 However, as the complexity of fractures needing treatment has changed from simple extra - articular supra - condylar types to inter - condylar and metaphyseal comminuted types, these implants may not be ideal. Double plating, and more recently, locked plating techniques have been advocated 5 . However with double plating there is often extensive soft tissue stripping on both sides of the femur, resulting in reduced blood supply and potential non - union and failure of the implants 6 . The LCP is a single beam construct where the strength of its fixation is equal to the sum of all screw - bone interfaces rather than a single screw’s axial stiffness or pullout resistance as seen in unlocked plates 7,8 . Its unique biomechanical function is based on splinting rather than compression resulting in flexible stabilization

  2. COHORT STUDY OF DISPLACED SUPRACONDYLAR FRACTURE TREATED IN TERTIARY CARE INSTITUTE IN PONDICHERY WITH RADIOLOGICAL ASSISTANCE WITH MEDIAL ‘K’ WIRE FIRST FROM 2008-2016

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    Aravindan Kalamegam

    2017-10-01

    Full Text Available BACKGROUND Supracondylar fracture in children when it is displaced, it is very difficult to reduce the fracture. That too after reduction, maintaining the reduction is very difficult. While reducing the fracture in closed reduction with lateral pinning first the result is not predictably good. Cross pinning will be giving mechanically stable fixation than lateral pinning alone. Lateral pinning alone imparts less rotational stability of fracture. Our aim of study is to prevent rotational instability by putting medial pinning first by avoiding the ulnar nerve injury using radiological assistance followed by lateral pinning. MATERIALS AND METHODS One hundred and six cases of displaced supracondylar fracture were included in study. The mean age of the patient was 7 yrs. (3-12 yrs., the male and female patient ratio was 72:34 and left side was involved in 63 patients whereas right side in 43 patients. The most common mode of trauma was fall from height on outstretched hand with elbow in extension. All the 106 patients were consecutively admitted. Patient had extension type of injury with 63 patients had Gartland type III fracture and 43 had Gartland type II fracture. Posteromedial displacement was noted in 63 patients whereas posterolateral displacement noted in 43 patients. In all cases, medial K wire was first inserted after closed reduction, then after stabilising the fractured rotation using image guidance. Lateral K-wire was removed on 3 weeks (21 days and follow up was done at 6 weeks and 12 weeks when they were evaluated according to Flynn’s criteria. RESULTS Results were graded according to Flynn’s criteria. CONCLUSION Medial K wire technique provides stable fixation and rotational stability has been correlated according to this technique.

  3. Does fluoroscopy improve outcomes in paediatric forearm fracture reduction?

    International Nuclear Information System (INIS)

    Menachem, S.; Sharfman, Z.T.; Perets, I.; Arami, A.; Eyal, G.; Drexler, M.; Chechik, O.

    2016-01-01

    Aim: To compare the radiographic results of paediatric forearm fracture reduced with and without fluoroscopic enhancement to investigate whether fractures reduced under fluoroscopic guidance would have smaller residual deformities and lower rates of re-reduction and surgery. Materials and methods: A retrospective cohort analysis was conducted comparing paediatric patients with acute forearm fracture in two trauma centres. Demographics and radiographic data from paediatric forearm fractures treated in Trauma Centre A with the aid of a C-arm fluoroscopy were compared to those treated without fluoroscopy in Trauma Centre B. Re-reduction, late displacement, post-reduction deformity, and need for surgical intervention were compared between the two groups. Results: The cohort included 229 children (175 boys and 54 girls, mean age 9.41±3.2 years, range 1–16 years) with unilateral forearm fractures (83 manipulated with fluoroscopy and 146 without). Thirty-four (15%) children underwent re-reduction procedures in the emergency department. Fifty-three (23%) children had secondary displacement in the cast, of which 18 were operated on, 20 were re-manipulated, and the remaining 15 were kept in the cast with an acceptable deformity. Twenty-nine additional children underwent operation for reasons other than secondary displacement. There were no significant differences in re-reduction and surgery rates or in post-reduction deformities between the two groups. Conclusion: The use of fluoroscopy during reduction of forearm fractures in the paediatric population apparently does not have a significant effect on patient outcomes. Reductions performed without fluoroscopy were comparably accurate in correcting deformities in both coronal and sagittal planes. - Highlights: • Compared outcomes of pediatric forearm fracture reduction with and without fluoroscopy. • The use of fluoroscopy during reduction of forearm fractures in the pediatric population apparently does not have a

  4. Orthopaedic resident preparedness for closed reduction and pinning of pediatric supracondylar fractures is improved by e-learning: a multisite randomized controlled study.

    Science.gov (United States)

    Hearty, Thomas; Maizels, Max; Pring, Maya; Mazur, John; Liu, Raymond; Sarwark, John; Janicki, Joseph

    2013-09-04

    There is a need to provide more efficient surgical training methods for orthopaedic residents. E-learning could possibly increase resident surgical preparedness, confidence, and comfort for surgery. Using closed reduction and pinning of pediatric supracondylar humeral fractures as the index case, we hypothesized that e-learning could increase resident knowledge acquisition for case preparation in the operating room. An e-learning surgical training module was created on the Computer Enhanced Visual Learning platform. The module provides a detailed and focused road map of the procedure utilizing a multimedia format. A multisite prospective randomized controlled study design compared residents who used a textbook for case preparation (control group) with residents who used the same textbook plus completed the e-learning module (test group). All subjects completed a sixty-question test on the theory and methods of the case. After completion of the test, the control group then completed the module as well. All subjects were surveyed on their opinion regarding the effectiveness of the module after performing an actual surgical case. Twenty-eight subjects with no previous experience in this surgery were enrolled at four academic centers. Subjects were randomized into two equal groups. The test group scored significantly better (p < 0.001) and demonstrated competence on the test compared with the control group; the mean correct test score (and standard deviation) was 90.9% ± 6.8% for the test group and 73.5% ± 6.4% for the control group. All residents surveyed (n = 27) agreed that the module is a useful supplement to traditional methods for case preparation and twenty-two of twenty-seven residents agreed that it reduced their anxiety during the case and improved their attention to surgical detail. E-learning using the Computer Enhanced Visual Learning platform significantly improved preparedness, confidence, and comfort with percutaneous closed reduction and pinning of a

  5. Complications of the surgical treatment early and tardy of supracondylar fractures of the humerus in children: a retrospective study of 111 patients treated at the Hospital Nacional de Ninos Carlos Saenz Herrera in the period January 2010 to January 2011

    International Nuclear Information System (INIS)

    Zuniga Blanco, Adrian

    2012-01-01

    Supracondylar fractures of the humerus up much of the emergency consultation of any pediatric orthopedic service, of them, Gartland III fractures are usually treated by closed reduction and percutaneous fixation with nails smooth. Often treatment has been delayed by factors such as the unavailability of an orthopedic specialist or local anesthesia or an operating room. At other times, the patient has come belatedly to consult. This retrospective study has analyzed whether a delay greater than 12 hours in the surgical treatment of supracondylar fractures of the humerus in children is associated with an increased risk of perioperative complications. Of 111 children who have been treated surgical in national children's hospital, underwent 59 surgeries before 12 hours from the trauma and 52 underwent surgery after 12 hours of trauma. The groups have developed without significant differences in terms of iatrogenic neurological injury, tract infection of the nails, vascular complications and compartment syndrome. Surgical time and hospital stay neither have had differences. In 2 cases of the tardy treatment group has been necessary to perform a opened reduction. As for the bad union, 9 cases (8%) have been of elbow varus radiological and clinical, of these 5 cases (4.5%) have occurred in the tardy treatment group and 4 cases (3,5) in the group early treatment. Findings of similar studies are confirmed in which the rate of perioperative complications is significantly unchanged if the surgical treatment is carried out before 12 hours or after 12 hours after the trauma. (author) [es

  6. Comparative endurance testing of the Biomet Matthews Nail and the Dynamic Compression Screw, in simulated condylar and supracondylar femoral fractures

    Directory of Open Access Journals (Sweden)

    Davies Benjamin M

    2008-01-01

    Full Text Available Abstract Background The dynamic compression screw is a plate and screws implant used to treat fractures of the distal femur. The Biomet Matthews Nail is a new retrograde intramedullary nail designed as an alternative surgical option to treat these fractures. The objective of this study was to assess the comparative endurance of both devices. Method The dynamic compression screw (DCS and Biomet Matthews Nail (BMN were implanted into composite femurs, which were subsequently cyclically loaded using a materials testing machine. Simulated fractures were applied to each femur prior to the application of load. Either a Y type fracture or a transverse osteotomy was prepared on each composite femur using a jig to enable consistent positioning of cuts. Results The Biomet Matthews Nail demonstrated a greater endurance limit load over the dynamic compression screw in both fracture configurations. Conclusion The distal locking screws pass through the Biomet Matthews Nail in a unique "cruciate" orientation. This allows for greater purchase in the bone of the femoral condyle and potentially improves the stability of the fracture fixation. As these fractures are usually in weak osteoporotic bone, the Biomet Matthews Nail represents a favourable surgical option in these patients.

  7. Fraturas supracondilares tipo III do úmero em crianças: tratamento com braço reto Type III supracondylar fractures of the humerus in children: straight-arm treatment

    Directory of Open Access Journals (Sweden)

    Jamish Gandhi

    2010-01-01

    Full Text Available INTRODUÇÃO: As fraturas supracondilares de Gartland tipo III são as lesões comuns em crianças. Apresentamos um método de redução manipulativa, imobilização e fixação usando gesso-de-Paris, com o cotovelo em extensão total (braço reto. MÉTODO: Estudo retrospectivo analisando todos os pacientes com fraturas supracondilares de Gartland tipo III no Wellington Public Hospital, durante o período de fevereiro de 1999 a março de 2007. Os sete pacientes foram tratados pela técnica do braço reto, e os desfechos clínicos foram revisados neste estudo. RESULTADO: Todos os pais ficaram satisfeitos com os resultados. Usando os critérios de Flynn,6 seis pacientes atingiram excelentes resultados e um teve resultado bom quando se analisou o ângulo de alinhamento. Ao verificar a amplitude de movimento, quatro pacientes tiveram resultados bons, um moderado e dois, ruim. CONCLUSÃO: O tratamento com braço reto das fraturas supracondilares de Gartland tipo III parece ser uma alternativa não-invasiva e segura da fixação com fio K.OBJECTIVE: Gartland type III supracondylar fractures are a common injury in children. We present a method of manipulative reduction, immobilization and fixation using Plaster of Paris with the elbow in full extension (straight-arm. METHOD: Retrospective study analyzing all patients with Gartland type III supracondylar fractures at the Wellington Public Hospital during the period from February 1999 to March 2007. The seven patients had been treated with the straight-arm technique, and the clinical outcomes are reviewed in this study. RESULT: All the parents were satisfied with the results. Using the Flynn criteria6, six patients achieved excellent results and one good, in relation to the carrying angle. With regard to the range of motion, four patients had good results, one fair, and two poor. CONCLUSION: Straight-arm treatment of Gartland type III supracondylar fractures appears to be a non-invasive and safe

  8. The emerging trend of non-operative treatment in paediatric type I open forearm fractures.

    Science.gov (United States)

    Zhang, H; Fanelli, M; Adams, C; Graham, J; Seeley, M

    2017-08-01

    Open fractures are considered an orthopaedic emergency and are generally an indication for operative debridement. Recent studies have questioned this approach for the management of Gustilo-Anderson Type I open fractures in the paediatric population. This meta-analysis studies the non-operative management of Type I open paediatric forearm fractures. An Ovid MEDLINE and PubMed database literature search was performed for studies that involved a quantified number of Gustilo-Anderson Type I open forearm fractures in the paediatric population, which were treated without operative intervention. A fixed-effect meta-analysis, weighting each study based on the number of patients, and a pooled estimate of infection risk (with 95% confidence interval (CI)) was performed. The search results yielded five studies that were eligible for inclusion. No included patients had operative debridement and all were treated with antibiotics. The number of patients in each study ranged from 3 to 45, with a total of 127 paediatric patients in the meta-analysis. The infection rate was 0% for all patients included. The meta-analysis estimated a pooled infection risk of 0% (95% CI 0 to 2.9). The five included studies had a total of 127 patients with no cases of infection after non-operative management of Type I open paediatric forearm fractures. The infection rate of Type I fractures among operatively managed patients is 1.9%. The trend in literature towards non-operative treatment of paediatric Type I open fractures holds true in this meta-analysis.

  9. Fratura supracondiliana do fêmur durante salto após reconstrução artroscópica do ligamento cruzado anterior Supracondylar emur fracture during jump after anterior cruciate ligament arthroscopic reconstruction

    Directory of Open Access Journals (Sweden)

    Thiago Yukio Fukuda

    2009-04-01

    with the established protocol. The patient presented good control and sensory-motor stability when he suffered a supracondylar femur fracture. This fracture occurred during a jump in the physical therapy treatment. The ligament reconstruction was done with the tendon graft of the knee flexors muscles, and the fracture caused later, was reduced and stabilized with plate and screw. Ten months after open reduction and internal fixation of the fracture, the patient showed regular function in the Lysholm scale, normal range of movement and muscular force grade V for knee flexors and extensors. DISCUSSION: Few case reports similar to the present one were found in the literature. The majority presented femur fracture after ACL reconstruction with patellar tendon. The present case shows significance by the association between supracondylar femur fracture with ligament reconstruction with flexors tendon, since only one case followed this direction. Two of the possible causes of this fracture are bone fragility for disuse and femoral tunnel bone bigger than the normal, despite not being a consensus. A hypothesis suggested by the authors of this paper is that the bone tunnel of graft fixation could have been a stress booster to the site of the fracture.

  10. Acute flexor tendon injury following midshaft radius and ulna fractures in a paediatric patient

    Directory of Open Access Journals (Sweden)

    James Williams

    2018-06-01

    Full Text Available Delayed rupture of the extensor and flexor tendons are recognised complications of distal radius fractures. However, acute flexor tendon rupture in the context of forearm fractures is rare. A twelve-year-old female sustained midshaft fractures of the radius and ulna. Intra-operatively the flexor pollicis longus (FPL was found to be stripped from its musculotendinous junction at the level of the fracture fragment. The ruptured tendon was repaired using a modified Krackow technique at the time of fracture fixation. The repair was protected in plaster of Paris prior to referral to the paediatric hand clinic. The patient made a full recovery. Flexor tendon injury is a rare but potentially devastating consequence of acute forearm fractures. High energy trauma, significant volar angulation of the fracture fragment and clinical signs of flexor tendon injury should raise suspicion of this injury. A high index of suspicion in conjunction with repeat clinical examination of flexor tendon function should be performed before opting for closed management or intramedullary nailing in paediatric patients. Keywords: Acute, Flexor, Tendon, Fracture, Radius, Paediatric

  11. Systematic review of spica casting for the treatment of paediatric diaphyseal femur fractures.

    Science.gov (United States)

    Tisherman, R T; Hoellwarth, J S; Mendelson, S A

    2018-04-01

    Paediatric femur fractures are commonly encountered and often successfully managed with spica casting. Despite spica casting's long history there is little formal guidance for optimal outcomes and no consolidation of existing literature. The purpose of this study is to review the available literature regarding the use of spica casting for the management of paediatric diaphyseal femur fractures. The PubMed database was queried for all research articles including the phrase "spica". A total of 788 abstracts were reviewed for relevance to the current study. Data was extracted from all available research studies which specified tolerance for fracture angulation or shortening in the cast. Additionally, all articles describing alternative materials, methods for spica application, and complications of spica casting were reviewed. In all, 106 articles were found relevant to the management of diaphyseal femur fractures in the paediatric population. The aggregated, accepted fracture shortening decreased from 16 mm to 18 mm before age ten years to 12 mm to 14 mm after puberty. Aggregated, accepted angulation decreased from 14° to 16° varus/valgus and 18° to 22° pro/recurvatum before age two years, to 6° to 8° and 10° to 12° by puberty, respectively. The overall reported complication rate was 19.6%, with the most common complication being skin compromise in 8.2% of patients, followed by unacceptable angulation at the fracture site in 4.2% of patients and excessive limb shortening in 1.9% of patients. This article reviews the available spica casting literature and compiles the available data. Spica casting offers a safe, effective means for definitive management of paediatric diaphyseal femur fractures. Future research identifying the rate and pattern of remodelling as it relates to angulation and shortening at various patient ages, particularly beyond the aforementioned norms, would be valuable to identify true biological tolerances versus accepted expert opinion

  12. Attritional rupture of extensor pollicis longus: a rare complication following elastic stable intramedullary nailing of a paediatric radial fracture.

    LENUS (Irish Health Repository)

    Sproule, James A

    2011-01-01

    Elastic stable intramedullary nail fixation has become established as an acceptable method of treatment for diaphyseal fractures of both forearm bones in the paediatric population. It is considered safe, minimally invasive and does not compromise physeal growth. We report a case of delayed rupture of extensor pollicis longus due to attrition over the sharp edges of a protruding nail end after elastic stable intramedullary nailing of a paediatric radial diaphyseal fracture.

  13. Fluoroscopy in paediatric fractures - Setting a local diagnostic reference level

    International Nuclear Information System (INIS)

    Pillai, A.; McAuley, A.; McMurray, K.; Jain, M.

    2006-01-01

    Background: The ionizing radiations (Medical Exposure) Regulation 2000 has made it mandatory to establish diagnostic reference levels (DRLs) for all typical radiological examinations. Objectives: We attempt to provide dose data for some common fluoroscopic procedures used in orthopaedic trauma that may be used as the basis for setting DRLs for paediatric patients. Materials and methods: The dose area product (DAP) in 865 paediatric trauma examinations was analysed. Median DAP values and screening times for each procedure type along with quartile values for each range are presented. Results: In the upper limb, elbow examinations had maximum exposure with a median DAP value of 1.21 cGy cm 2 . Median DAP values for forearm and wrist examinations were 0.708 and 0.538 cGy cm 2 , respectively. In lower limb, tibia and fibula examinations had a median DAP value of 3.23 cGy cm 2 followed by ankle examinations with a median DAP of 3.10 cGy cm 2 . The rounded third quartile DAP value for each distribution can be used as a provisional DRL for the specific procedure type. (authors)

  14. Ender’s Nail fixation in paediatric femoral shaft fractures.

    Directory of Open Access Journals (Sweden)

    Rajeev Dwivedi

    2013-12-01

    Flynn criteria 34 had excellent and 6 had satisfactory results. No poor results were seen. Conclusion: Ender’s nail fixation can be preferred method of treatment for femoral shaft fractures in age group 5 -15 years as the results are excellent and satisfactory. It is technically simple and can be done in a closed manner. It spares the vascularity and growth plate.

  15. Fratura supracondiliana de úmero em crianças: fixação com dois fios de Kirschner cruzados Supracondylar fracture of the humerus in children: fixation with two crossed Kirschner wires

    Directory of Open Access Journals (Sweden)

    Roni Azevedo Carvalho

    2012-01-01

    Full Text Available OBJETIVO: Analisar e apresentar os resultados de fraturas supracondilianas instáveis de úmero em crianças, tratadas cirurgicamente com redução e fixação percutânea com dois fios de Kirschner cruzados. MÉTODOS: Foi realizado estudo transversal com 20 crianças, considerando sexo, idade na época da fratura e no momento da análise, lateralidade, tipo e mecanismo de fratura, complicações pós-operatórias, variáveis radiográficas e clínicas. RESULTADOS: Observaram-se 10 fraturas à esquerda e 10 à direita. A idade na fratura variou de dois a 13 anos (média 5,9 anos ± 2,48. Três fraturas foram classificadas como tipo II e 17 do tipo III. O tempo de seguimento variou de quatro meses a três anos. O ângulo de Baumann variou de 69 a 100 (média 78,3, sendo observada a presença de cúbito varo em quatro pacientes (com valores variando de 84 a 100. Segundo os critérios de Flynn modificados, obtiveram-se 20 casos satisfatórios, 17 excelentes (85%, dois bons (10% e um regular (5%. Dois pacientes apresentaram déficit da amplitude de movimento, dois parestesia no território cubital e uma criança apresentou neuropraxia transitória do nervo ulnar por seis semanas. CONCLUSÃO: A fixação percutânea com dois fios de Kirschner cruzados, quando realizada com visualização direta e isolamento do nervo ulnar, permite bons resultados.OBJECTIVE: To analyze and present the surgical results from unstable supracondylar fractures of the humerus in children, treated by means of reduction and percutaneous fixation using two crossed Kirschner wires. METHODS: A cross-sectional study was conducted on 20 children, taking into consideration sex, age at the time of the fracture, age at the time of the assessment, side affected, type and mechanism of trauma, postoperative complications and radiographic and clinic variables. RESULTS: Ten fractures were observed in the left arm and ten in the right arm. The age at the time of the fracture ranged from 2

  16. The effect of canal fill on paediatric femur fractures treated with titanium elastic nails.

    Science.gov (United States)

    Nielsen, E; Bonsu, N; Andras, L M; Goldstein, R Y

    2018-02-01

    Traditional teaching for fixation of paediatric femur fractures recommends 80% nail diameter/medullary canal diameter ratio (ND/MCD) for successful maintenance of reduction. Prior studies have investigated this with stainless steel Enders nails. Our aim was to assess the impact of ND/MCD on maintenance of reduction and malunion rates in paediatric femur fractures treated with flexible intramedullary nails (FINs). Retrospective data was collected on all paediatric patients treated with FINs for diaphyseal femur fractures at a single tertiary care institution over a ten-year period. Patients with co-morbidities affecting bone quality were excluded. Patients were subdivided into groups based on ND/MCD. A total of 66 patients met inclusion criteria. Mean ND/MCD was 76.3% (32.9% to 98.8%, SD 14.3). In all, 50% (n = 33/66) of patients had > 80% ND/MCD, and only 13.6% (n = 9/66) of patients had less than 60% ND/MCD. When controlling for fracture stability, ND/MCD had no correlation with mean shortening (p = 0.07) There was no correlation between ND/MCD and angulation in the sagittal (p = 0.96) or coronal plane (p = 0.20). Three patients fit malunion criteria. ND/MCD for these patients were 40%, 67% and 79%. There was no correlation between ND/MCD and shortening or malangulation. The majority of patients in this series with less than 80% fill with FIN healed within acceptable parameters. III.

  17. Isolated Medial Orbital Wall Fracture Associated with Enophthalmos in a Paediatric Patient: An Unusual Presentation

    Directory of Open Access Journals (Sweden)

    Panagiotis Giannakouras

    2018-02-01

    Full Text Available Purpose: To report a case of isolated medial orbital wall fracture with enophthalmos in a paediatric patient and describe the clinical presentation and findings by means of computed tomography (CT of the head and eyes. Methods: We looked at the patient’s medical and ophthalmologic history, and an ophthalmologic examination and a CT of the head were performed at baseline. Results: A 14-year-old boy was admitted to the emergency department of our institution with ecchymosis of his right eyelids secondary to a sport accident. Physical examination revealed a moderate limitation of upgaze without diplopia. CT showed a medial orbital wall fracture without haemorrhage and a gross accumulation of air in the right eyelid with pressure exertion over the right globe and enophthalmos. The patient was treated conservatively with oral antibiotics and steroids showing dramatic improvement within 1 week. Enophthalmos and periorbital emphysema were completely resolved within 3 months after the accident as indicated by CT. Conclusions: We conclude that surgical intervention and intravenous treatment are not warranted in similar cases of medial orbital wall fracture. Medical history, clinical and paraclinical evaluations, and a regular follow-up, including CT, are needed though to avoid complications such as painful abduction, horizontal diplopia, pseudo sixth nerve paresis, or pseudo Duane.

  18. Flexible Intramedullary Nailing for Paediatric Shaft of Femur Fractures – Does the Number of Nails Alter the Outcome?

    Directory of Open Access Journals (Sweden)

    B Kanthimathi

    2011-07-01

    Full Text Available BACKGROUND: The use of flexible intramedullary nailing, allowing micro movement at the fracture site, results in excellent outcomes regardless of the number of nails used. We undertook analysis of the outcomes of flexible nailing with reference to the number of nails used. METHODS: Twenty patients with diaphyseal femur fracture aged 5-15 years were treated with retrograde flexible intramedullary nailing. The number of nails varied from single to multiple. The results were analysed with regard to the number of nails used. RESULTS: The mean patient age was 7.9 years; patients were followed up for a mean duration of 13.2 months. Those with two and three nails had similar results. CONCLUSION: A minimum of two flexible nails is needed for optimal fixation in paediatric femur shaft fractures. Also, limiting the number of implants to two is cost effective, decreases operative time, reduces radiation exposure and offers equal results to that of three nails.

  19. pattern of long bone fractures in a paediatric population at kenyatta

    African Journals Online (AJOL)

    attributed to increased sporting activity, which cause up to 39% of the ... severity and location at time of injury in the paediatric age group. Design: This .... investigator. Data management and analysis: Collected data was ..... children and youth.

  20. Comparative Study Using Intramedullary K-wire Fixation Over Titanium Elastic Nail in Paediatric Shaft Femur Fractures.

    Science.gov (United States)

    Kumar, Sanjiv; Anand, Tushar; Singh, Sudhir

    2014-11-01

    Fracture shaft femur is common paediatric trauma leading to significant morbidity. Conservative treatments available are associated with prolonged periods of immobilization. Use of flexible intramedullary implant allows early rehabilitation in diaphyseal fractures of femur in children. The aim of the present study is to compare fixation of diaphyseal femur fracture by titanium elastic nail and intramedullary K-wires in children. Prospective randomized study in a tertiary care hospital. Fifty-two children between 6 years and 14 years of age with femoral shaft fracture were assigned either in Group I or Group II based on computer generated random numbers. In Group I closed percutaneous intramedullary K- wire fixation and in Group II closed percutaneous intramedullary titanium elastic nail was used to fix the fractures. Partial weight bearing was allowed after 6 weeks of surgery and full weight bearing at clinico-radiological union. Average time of radiological union was 6 to 10 weeks in both groups. In both the groups two cases had entry site irritation which resolved with early implant removal. One case in both the groups had unacceptable mal-alignment. Both the groups had few cases of limb-length discrepancy, which was in acceptable limit, except two cases of TENS. There was no statistically significant difference between the results of both the groups. But, using K-wires significantly reduced the cost of treatment. Most of such fractures in our society are neglected because of high cost of treatment. Providing a cheaper alternative in form of K-wires may be beneficial for the patients from low socio-economic status.

  1. Internal antecubital fold line: A new useful anatomical repair to identify the medial epicondyle and avoid iatrogenic ulnar nerve injury in patients with supracondylar fracture of the humerus Línea del pliegue antecubital interno: Un nuevo reparo anatómico útil para identificar la epitróclea y evitar lesiones iatrogénicas del nervio ulnar en pacientes con fractura supracondílea del humero

    Directory of Open Access Journals (Sweden)

    Luis José Cespedes

    2012-12-01

    Full Text Available Introduction: The supracondylar fracture of the distal humerus is the most common pediatric fracture around the elbow. The currently accepted techniques of fixation are two lateral parallel wires , crosswiring technique from the lateral side, two divergent wires laterally and two retrograde crossed wires. The retrograde crossed wires provide the best mechanical stability. Many children with this fracture have swelling around the elbow, making difficult the feeling of the anatomic landmarks for percutaneous pinning, increasing the risk of ulnar nerve injury. Objective: To evaluate the correspondence of the internal antecubital fold line with the internal epicondyle in patients with supracondylar fracture and the incidence of iatrogenic ulnar nerve injuries . Methods: We conducted a series of clinical cases. In the first group we included 56 children with supracondylar fracture Gartland type III, from August 2000 to September 2007, who underwent closed reduction and crossed retrograde nail fixation. In the second group we included 241 (481 elbows outpatients with no anatomic abnormality. We used the extension of antecubital fold line to find the internal epicondyle in both groups. Results: The prolongation of the antecubital fold line intersected the medial epicondyle in all participants of the first group. In 96.3% of the participants in the second group, the extension of antecubital fold line intersected the internal epicondyle. None patient had iatrogenic ulnar nerve injury. Conclusions: The use of the antecubital internal fold line may be useful to identify the internal epicondyle and thus avoid iatrogenic ulnar nerve injury. Salud UIS 2012; 44 (2: 9-14La fractura supracondílea del húmero distal es la más común alrededor del codo en niños. Las técnicas actualmente aceptadas de fijación son dos clavos laterales paralelos, dos clavos cruzados laterales, dos clavos laterales divergentes y dos clavos retrógrados cruzados. Los clavos retr

  2. A paediatric case of bilateral mandibular condyle fracture presenting with bloody otorrhoea following trauma.

    Science.gov (United States)

    Chan, Yat Chun; Au-Yeung, Kwan Leong

    2017-04-22

    A 7-year-old boy presented to the emergency department with bilateral bloody otorrhoea after falling from his scooter. Skull base fracture was suspected. CT showed no evidence of skull base fracture but bilateral mandibular condyle and external acoustic canals fractures. We report this case to illustrate a rare possibility of bilateral external acoustic canal fracture associated with condylar fracture in trauma patients presented with bloody otorrhoea. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  3. Who are we missing? Too few skeletal surveys for children with humeral and femoral fractures

    International Nuclear Information System (INIS)

    Shelmerdine, S.C.; Das, R.; Ingram, M.D.; Negus, S.

    2014-01-01

    Aim: To determine the potential shortfall in skeletal survey referral for children presenting with an acute non-supracondylar humeral or femoral fracture. Materials and methods: Plain radiograph reports were reviewed retrospectively using the radiology information system database over a 5 year study period (May 2008–2013) in children under 18 months of age who presented with an acute fracture. Subsequent skeletal survey referral was used as a surrogate marker for further investigation of child abuse. Application of robust meta-analysis derived probability data regarding likelihood of child abuse as a cause of non-supracondylar humeral or femoral fracture was applied. An estimation of the expected number of cases of abuse, with shortfall in skeletal survey referrals, was then calculated. Results: There were 288 fractures in 281 children. Three children presented with multiple fractures and were considered separately in the present data. The mean patient age was 10.5 months. Nine (3%) non-supracondylar humeral fractures were identified of which four cases may have been due to non-accidental injury (NAI). One (11%) of these patients was referred for a skeletal survey indicating a potential shortfall of three referrals. Twenty-five (9%) femoral fractures were identified of which 13 cases may have been due to NAI, with six (24%) referrals for skeletal surveys generated. This indicates a potential shortfall of seven referrals. Conclusion: The present study serves as a current analysis of practice within a tertiary paediatric referral centre. There appeared to be local under-investigation of NAI. Improved child protection education and awareness programmes have now been introduced. - Highlights: • Long bone fractures in non-ambulatory children carry high probability for child abuse. • Suspicion for child abuse should trigger a referral for a skeletal survey. • We examine the potential shortfall in skeletal survey referrals in such patients. • Only 11% and 24% of

  4. Fractured tracheostomy tube presenting as a foreign body in a paediatric patient

    Science.gov (United States)

    Gupta, Suman Lata; Swaminathan, Srinivasan; Ramya, Ravivalar; Parida, Satyen

    2016-01-01

    Tracheostomy tube fracture and aspiration into the tracheobronchial tree leading to airway obstruction is a dangerous complication after tracheostomy. We report a case of a fractured tracheostomy tube in a 6-year-old child who had been maintained on a tracheostomy tube for the past 5 years. The tracheostomy tube got fractured at the junction of the tube and neck plate, and impacted in the trachea and right main bronchus. Rigid bronchoscopy performed through the tracheostomy stoma to retrieve the fractured tracheostomy tube and the anaesthetic management during the period are discussed. PMID:26957033

  5. An evaluation of flexible intramedullary nail fixation in femoral shaft fractures in paediatric age group.

    Science.gov (United States)

    Kumar, Sanjay; Roy, Sandip Kumar; Jha, Amrish Kumar; Chatterjee, Debdutta; Banerjee, Debabrata; Garg, Anant Kumar

    2011-06-01

    Sixty-two femoral shaft fractures in 60 patients treated by elastic intramedullary nailing with mean age of the patients being 9.2 years (range 5 years to 12 years) and average follow-up of 15 months (range 7 months to 60 months) are evaluated. Twenty-eight fractures were fixed with titanium elastic nail while 34 fractures were fixed with Enders nail. There were 40 midshaft fractures, 18 proximal femoral and 4 were fractures of distal third. Fracture patterns were transverse in 35, short oblique in 14 cases and 13 were spiral fractures. Mean age of union in this series was 17 weeks (range 12 weeks to 28 weeks). Ten cases had complications, 5 had nail tip irritation, 3 varus or valgus malalignment and 2 had delayed union. In this series, we did not have any non-union, refracture, limb length discrepancy or any major infection. The result demonstrates 100% union rate irrespective of the age, weight and height of the patient. Regardless of the site of fracture and their pattern, it united every time with elastic nail fixation. We did not find and mismatch in the results of fractures stabilised with titanium elastic nail with that of elastic stainless steel nail.

  6. Post-traumatic cortical cysts in paediatric fractures: is it a concern for emergency doctors?

    DEFF Research Database (Denmark)

    Houshian, Shirzad; Pedersen, Niels Wisbech; Torfing, Trine

    2007-01-01

    fracture in the femur, which is not previously published in the literature. The cyst-like lesion appeared as an oval radiolucency proximal to the previous fracture site on radiograph films. These lesions can cause concern for the on-call teams as they can mimic an infection or a tumour of the bone. We...

  7. Paediatric tibial shaft fractures treated by open reduction and stabilization with monolateral external fixation.

    Science.gov (United States)

    Simon, A-L; Apostolou, N; Vidal, C; Ferrero, E; Mazda, K; Ilharreborde, B

    2018-02-01

    Elastic stable intramedullary nailing is increasingly used for surgical treatment of tibial shaft fractures, but frequently requires immobilization and delayed full weight-bearing. Therefore, external fixation remains interesting. The aim was to report clinico-radiological outcomes of monolateral external fixation for displaced and unstable tibial shaft fractures in children. All tibial fractures consecutively treated by monolateral external fixation between 2008 and 2013 were followed. Inclusion criteria included skeletal immaturity and closed and open Gustilo I fractures caused by a direct impact. Patients were seen until two years postoperatively. Demographics, mechanism of injury, surgical data and complications were recorded. Anteroposterior and lateral side radiographs were performed at each visit. Full-limb 3D reconstructions using biplanar stereroradiography was performed for final limb length and alignment measures. A total of 45 patients (mean age 9.7 years ± 0.5) were included. In all, 17 were Gustilo I fractures, with no difference between open and closed fractures for any data. Mean time to full weight bearing was 18.2 days ± 0.7. After 15 days, 39 patients returned to school. Hardware removal (mean time to union 15.6 weeks ± 0.8) was performed during consultation under analgesic gas. There were no cases of nonunion. No fracture healed with > 10° of angulation (mean 5.1° ± 0.4°). Leg-length discrepancy > 10 mm was found for six patients. This procedure can be a safe and simple surgical treatment for children with tibial shaft fractures. Few complications and early return to school were reported, with the limitations of non-comparative study. IV.

  8. Paediatric tibial shaft fractures treated by open reduction and stabilization with monolateral external fixation

    Science.gov (United States)

    Simon, A.-L.; Apostolou, N.; Vidal, C.; Ferrero, E.; Mazda, K.; Ilharreborde, B.

    2018-01-01

    Abstract Purpose Elastic stable intramedullary nailing is increasingly used for surgical treatment of tibial shaft fractures, but frequently requires immobilization and delayed full weight-bearing. Therefore, external fixation remains interesting. The aim was to report clinico-radiological outcomes of monolateral external fixation for displaced and unstable tibial shaft fractures in children. Methods All tibial fractures consecutively treated by monolateral external fixation between 2008 and 2013 were followed. Inclusion criteria included skeletal immaturity and closed and open Gustilo I fractures caused by a direct impact. Patients were seen until two years postoperatively. Demographics, mechanism of injury, surgical data and complications were recorded. Anteroposterior and lateral side radiographs were performed at each visit. Full-limb 3D reconstructions using biplanar stereroradiography was performed for final limb length and alignment measures. Results A total of 45 patients (mean age 9.7 years ± 0.5) were included. In all, 17 were Gustilo I fractures, with no difference between open and closed fractures for any data. Mean time to full weight bearing was 18.2 days ± 0.7. After 15 days, 39 patients returned to school. Hardware removal (mean time to union 15.6 weeks ± 0.8) was performed during consultation under analgesic gas. There were no cases of nonunion. No fracture healed with > 10° of angulation (mean 5.1° ± 0.4°). Leg-length discrepancy > 10 mm was found for six patients. Conclusions This procedure can be a safe and simple surgical treatment for children with tibial shaft fractures. Few complications and early return to school were reported, with the limitations of non-comparative study. Level of Evidence IV PMID:29456750

  9. Paediatric diaphyseal femur fracture treated with intramedullary titanium elastic nail system

    Directory of Open Access Journals (Sweden)

    Shrawan Kumar Thapa

    2015-11-01

    Full Text Available noBackground & Objectives: Over the few years there has been a marked increase in the use of intramedullary fixation in the management of fracture of shaft of femur in children. The goals should be to stabilize the fracture, to control length and alignment, to promote bone healing and to minimize the morbidity and complications for the child. In this prospective study we intend to evaluate the functional and radiological outcome of diaphyseal fracture of shaft of femur treated with elastic intramedullary nail.Materials & Methods: All 56 patients with diaphyseal fracture shaft of femur were treated with titanium elastic nail and followed for period of 32 weeks.Results: The In this study, outcome was assessed by using Flynn’s criteria of titanium flexible nail outcome score and we found excellent result in 49 cases, satisfactory in six cases and poor in one case. We faced one major complication in form of implant failure and six minor complications inform of superficial wound infection.Conclusion: Elastic intramedullary nail used in treatment of diaphyseal fracture shaft of femur yield excellent functional and radiological outcome. It is easy and simple procedure has low rate of complication. It is physeal-protective, cost effective, does not involve heavy instrumentation and can be performed in small set up. It has minimal risk of infection and no risk of injury to the neurovascular structure.JCMS Nepal. 2015; 11(2:20-22

  10. Forensic aspects of paediatric fractures. Differentiating accidental trauma from child abuse

    International Nuclear Information System (INIS)

    Bilo, Rob A.C.

    2010-01-01

    Fractures are a common finding in children and it is estimated that 2.1% of all children will suffer at least one fracture before the age of 16. With young children in particular, the question may arise if this is related to child abuse. The aim of this book is to help physicians involved in child abuse cases to interpret radiological findings in light of the forensic circumstances under which they occurred. The authors present up-to-date literature related to the mechanisms underlying non-accidental cases of trauma. In this book not only the radiological findings in child-abuse are discussed, but more importantly, these findings are analyzed from a forensic perspective. Careful attention is paid to evidence regarding reported trauma mechanisms and their clinical outcome; for example, can a fall from a couch result in a femoral fracture, and if not, where is the supporting evidence? (orig.)

  11. Forensic aspects of paediatric fractures. Differentiating accidental trauma from child abuse

    Energy Technology Data Exchange (ETDEWEB)

    Bilo, Rob A.C. [Netherlands Forensic Institute, The Hague (Netherlands). Department of Pathology and Toxicology; Rijn, Rick R. van [Emma Childrens' s Hospital/Academic, Medical Center Amsterdam (Netherlands). Department of Radiology; Robben, Simon G.F. [Maastricht University Medical Center, Maastricht (Netherlands)

    2010-07-01

    Fractures are a common finding in children and it is estimated that 2.1% of all children will suffer at least one fracture before the age of 16. With young children in particular, the question may arise if this is related to child abuse. The aim of this book is to help physicians involved in child abuse cases to interpret radiological findings in light of the forensic circumstances under which they occurred. The authors present up-to-date literature related to the mechanisms underlying non-accidental cases of trauma. In this book not only the radiological findings in child-abuse are discussed, but more importantly, these findings are analyzed from a forensic perspective. Careful attention is paid to evidence regarding reported trauma mechanisms and their clinical outcome; for example, can a fall from a couch result in a femoral fracture, and if not, where is the supporting evidence? (orig.)

  12. "Floating arm" injury in a child with fractures of the proximal and distal parts of the humerus: a case report

    Directory of Open Access Journals (Sweden)

    Güven Melih

    2009-09-01

    Full Text Available Abstract Introduction Simultaneous supracondylar humerus fracture and ipsilateral fracture of the proximal humerus in children is rare. Case presentation A 10-year-old Turkish boy with an extension type supracondylar humerus fracture and ipsilateral fracture at the proximal metaphyseal-diaphyseal junction of the humerus was treated by closed reduction and percutaneous Kirschner wire fixation. Closed reduction was performed using a Kirschner wire as a "joystick" to manipulate the humeral shaft after some swelling occurred around the elbow and shoulder. Conclusion The combination of fractures at the proximal and distal parts of the humerus can be termed as "floating arm" injury. Initial treatment of this unusual injury should be focused on the supracondylar humerus fracture. However, closed reduction can be difficult to perform with the swelling around the elbow and shoulder. A temporary Kirschner wire can be used as a "joystick" to fix and reduce the fracture.

  13. The proportion of distal fibula Salter-Harris type I epiphyseal fracture in the paediatric population with acute ankle injury

    DEFF Research Database (Denmark)

    Hofsli, Mikael; Torfing, Trine; Al-Aubaidi, Zaid

    2016-01-01

    Ankle injuries are common among the paediatric population. There are few prospective studies utilizing MRI to diagnose a clinically suspected Salter-Harris type I of the distal fibula (SH1FDF). The aim of this study was to examine the proportion of clinically suspected SH1FDF in children. All...

  14. Trochanteric Stress Fracture in a Female Window Cleaner

    OpenAIRE

    Lee, Bong-Jin; Song, Jyewon

    2016-01-01

    Stress fractures may occur at various sites in the femur including the head, neck, shaft, supracondylar and condylar regions. To the best of our knowledge, stress fracture occurring in the trochanteric region has not been previously reported. We report here a case of trochanteric stress fracture in a 53-year-old female window cleaner treated with hip nailing without adverse consequences. Careful consideration of this entity is needed when evaluating patients who have repetitive jumping up and...

  15. Pediatric elbow fractures: a new angle on an old topic

    Energy Technology Data Exchange (ETDEWEB)

    Emery, Kathleen H.; Anton, Christopher G. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Zingula, Shannon N. [Mayo Clinic, Department of Radiology, Rochester, MN (United States); Salisbury, Shelia R. [Cincinnati Children' s Hospital Medical Center, Biostatistics and Epidemiology, Cincinnati, OH (United States); Tamai, Junichi [Cincinnati Children' s Hospital Medical Center, Department of Pediatric Orthopedics, Cincinnati, OH (United States)

    2016-01-15

    The three most common elbow fractures classically reported in pediatric orthopedic literature are supracondylar (50-70%), lateral condylar (17-34%), and medial epicondylar fractures (10%), with fractures of the proximal radius (including but not limited to fractures of the radial neck) being relatively uncommon (5-10%). Our experience at a large children's hospital suggests a different distribution. Our goals were (1) to ascertain the frequency of different elbow fracture types in a large pediatric population, and (2) to determine which fracture types were occult on initial radiographs but detected on follow-up. Review of medical records identified 462 children, median age 6 years and interquartile range for age of 4-8 years (range 0.8-18 years), who were diagnosed with elbow fractures at our institution over a 10-month period. Initial and follow-up radiographs were reviewed in blinded fashion independently by two experienced pediatric musculoskeletal radiologists to identify fracture types on initial and follow-up radiographs. The most common fractures included supracondylar (n = 258, 56%), radial neck (n = 80, 17%), and lateral condylar (n = 69, 15%). Additional fractures were seen on follow-up exams in 32 children. Of these, 25 had a different fracture type than was identified on initial radiographs. The most common follow-up fractures were olecranon (n = 23, 72%), coronoid process (n = 4, 13%) and supracondylar (n = 3, 9%). Olecranon fractures were significantly more common on follow-up radiographs than they were on initial radiographs (n = 33, 7%; P <.0001). Twenty-six children had more than one fracture type on the initial radiograph. The most common fracture combinations were radial neck with olecranon (n = 9) and supracondylar with lateral condylar (n = 9). Supracondylar fractures are the most frequent elbow fracture seen initially, followed by radial neck, lateral condylar, and olecranon fractures in a distribution different from what has been

  16. Management of paediatric tibial fractures using two types of circular external fixator: Taylor spatial frame and Ilizarov circular fixator.

    Science.gov (United States)

    Tafazal, Suhayl; Madan, Sanjeev S; Ali, Farhan; Padman, Manoj; Swift, Simone; Jones, Stanley; Fernandes, James A

    2014-05-01

    The use of circular fixators for the treatment of tibial fractures is well established in the literature. The aim of this study was to compare the Ilizarov circular fixator (ICF) with the Taylor spatial frame (TSF) in terms of treatment results in consecutive patients with tibial fractures that required operative management. A retrospective analysis of patient records and radiographs was performed to obtain patient data, information on injury sustained, the operative technique used, time duration in frame, healing time and complications of treatment. The minimum follow-up was 24 months. Ten patients were treated with ICF between 2000 and 2005, while 15 patients have been treated with TSF since 2005. Two of the 10 treated with ICF and 5 of the 15 treated with TSF were open fractures. All patients went on to achieve complete union. Mean duration in the frame was 12.7 weeks for ICF and 14.8 weeks for the TSF group. Two patients in the TSF group had delayed union and required additional procedures including adjustment of fixator and bone grafting. There was one malunion in the TSF group that required osteotomy and reapplication of frame. There were seven and nine pin-site infections in the ICF and TSF groups, respectively, all of which responded to antibiotics. There were no refractures in either group. In an appropriate patient, both types of circular fixator are equally effective but have different characteristics, with TSF allowing for postoperative deformity correction. Of concern are the two cases of delayed union in the TSF group, all in patients with high-energy injuries. We feel another larger study is required to provide further clarity in this matter. Level II-comparative study.

  17. MR imaging of occult fractures of the knee

    International Nuclear Information System (INIS)

    Mink, J.H.; Deutsch, A.L.

    1988-01-01

    The authors encountered 65 radiographically occult fractures that they classified into five types. Bone bruises were a result of direct trauma or were associated with ligamentous injury. They were characterized by geographic foci of decreased signal on short repetition time (TR), short echo time (TE) sequences. Stress fractures were linear or globular foci of low signal on short TR, short TE sequences. Osteochondral fractures were displaced or impacted types; the latter were often associated with an anterior cruciate ligament tear. Tibial fractures were minimally displaced, vertically oriented fractures extending into the plateaus. Femoral fractures were Y-shaped, extending across the supracondylar region

  18. Basic principles of fracture treatment in children.

    Science.gov (United States)

    Ömeroğlu, Hakan

    2018-04-01

    This review aims to summarize the basic treatment principles of fractures according to their types and general management principles of special conditions including physeal fractures, multiple fractures, open fractures, and pathologic fractures in children. Definition of the fracture is needed for better understanding the injury mechanism, planning a proper treatment strategy, and estimating the prognosis. As the healing process is less complicated, remodeling capacity is higher and non-union is rare, the fractures in children are commonly treated by non-surgical methods. Surgical treatment is preferred in children with multiple injuries, in open fractures, in some pathologic fractures, in fractures with coexisting vascular injuries, in fractures which have a history of failed initial conservative treatment and in fractures in which the conservative treatment has no/little value such as femur neck fractures, some physeal fractures, displaced extension and flexion type humerus supracondylar fractures, displaced humerus lateral condyle fractures, femur, tibia and forearm shaft fractures in older children and adolescents and unstable pelvis and acetabulum fractures. Most of the fractures in children can successfully be treated by non-surgical methods.

  19. PAEDIATRIC SURGERY

    African Journals Online (AJOL)

    in increased mortality in developing nations.6,7 However, it has been shown ... Background: The time from birth to the first paediatric surgical consultation of neonates with gastroschisis is a predictor ... of Helsinki and its later amendments. Informed consent was obtained from the parents of the infants included in the study.

  20. Paediatric Interventional Uroradiology

    International Nuclear Information System (INIS)

    Barnacle, Alex M.; Wilkinson, A. Graham; Roebuck, Derek J.

    2011-01-01

    Paediatric interventional uroradiology lies at the intersection of the disciplines of paediatric interventional radiology and paediatric endourology. Interdisciplinary collaboration has led to the development of new techniques and refinement of procedures adopted from adult practice. This article reviews the major procedures used in paediatric interventional uroradiology, with emphasis on nephrostomy, percutaneous nephrolithotomy, balloon-burst pyeloplasty, and antegrade ureteric stenting.

  1. Osteoporosis in paediatric patients with spina bifida.

    Science.gov (United States)

    Marreiros, Humberto; Marreiros, Humberto Filipe; Loff, Clara; Calado, Eulalia

    2012-01-01

    The prevalence and morbidity associated with osteoporosis and fractures in patients with spina bifida (SB) highlight the importance of osteoporosis prevention and treatment in early childhood; however, the issue has received little attention. The method for the selection of appropriate patients for drug treatment has not been clarified. To review the literature concerning fracture risks and low bone density in paediatric patients with SB. We looked for studies describing state-of-the-art treatments and for prevention of secondary osteoporosis. Articles were identified through a search in the electronic database (PUBMED) supplemented with reviews of the reference lists of selected papers. The main outcome measures were incidence of fractures and risk factors for fracture, an association between bone mineral density (BMD) and occurrence of fracture, risk factors of low BMD, and effects of pharmacological and non-pharmacological treatments on BMD and on the incidence of fractures. We considered as a secondary outcome the occurrence of fractures in relation to the mechanism of injury. Results indicated that patients with SB are at increased risk for fractures and low BMD. Risk factors that may predispose patients to fractures include higher levels of neurological involvement, non-ambulatory status, physical inactivity, hypercalciuria, higher body fat levels, contractures, and a previous spontaneous fracture. Limitations were observed in the number and quality of studies concerning osteoporosis prevention and treatment in paediatric patients with SB. The safety and efficiency of drugs to treat osteoporosis in adults have not been evaluated satisfactorily in children with SB.

  2. The Floating Upper Limb: Multiple Injuries Involving Ipsilateral, Proximal, Humeral, Supracondylar, and Distal Radial Limb.

    Science.gov (United States)

    Manaan, Qazi; Bashir, Adil; Zahoor, Adnan; Mokhdomi, Taseem A; Danish, Qazi

    2016-09-01

    Floating arm injury represents a common yet complicated injury of the childhood severely associated with limb deformation and even morbidity, if not precisely addressed and credibly operated. Here, we report a rare floating upper limb case of a 9-year-old boy with multiple injuries of ipsilateral proximal humeral, supracondylar and distal radial limb. This is the first report to document such a combined floating elbow and floating arm injury in the same limb. In this report, we discuss the surgical procedures used and recovery of the patient monitored to ascertain the effectiveness of the method in limb reorganisation.

  3. Osteoporosis in paediatric patients with spina bifida

    OpenAIRE

    Marreiros, Humberto; Loff, Clara; Calado, Eulalia

    2012-01-01

    The prevalence andmorbidity associated with osteoporosis and fractures in patients with spina bifida (SB) highlight the importance of osteoporosis prevention and treatment in early childhood; however, the issue has received little attention. The method for the selection of appropriate patients for drug treatment has not been clarified. Objective: To review the literature concerning fracture risks and low bone density in paediatric patients with SB. We looked for studies describing state...

  4. Skin puckering an uncommon sign of underlying humeral neck fracture: a case report.

    LENUS (Irish Health Repository)

    Davarinos, N

    2012-01-31

    Skin puckering is a sign that is well associated with certain fractures such as supracondylar humeral fractures in children. To our knowledge, there has been only one clinical report of skin puckering associated with fractured neck of humerus of an adult. This is a second such case of fractured proximal humerus in an adult presenting with skin puckering and the first from the Republic of Ireland. Skin puckering is suggestive of soft tissue interposition and may be an important clinical sign indicating the need for internal fixation.

  5. Preexisting lesions associated with complete diaphyseal fractures of the third metacarpal bone in 12 Thoroughbred racehorses.

    Science.gov (United States)

    Gray, Sarah N; Spriet, Mathieu; Garcia, Tanya C; Uzal, Francisco A; Stover, Susan M

    2017-07-01

    We characterized features of complete diaphyseal fractures of third metacarpal bones in Thoroughbred racehorses. Given that stress fractures are known to occur in the third metacarpal bone, an additional aim was to determine if complete fractures are associated with signs of a preexisting incomplete stress fracture. Bilateral metacarpi from 12 Thoroughbred racehorses euthanized because of complete unilateral metacarpal diaphyseal fracture were examined visually and radiographically. Open, comminuted, transverse or short oblique fractures occurred in the middle of the diaphysis or supracondylar region. Periosteal surface discoloration and bone callus formation contiguous with the fracture line were present in fractured bones. All contralateral intact metacarpi had gross anatomic lesions, and 10 had radiographic abnormalities similar to those observed on fractured metacarpi. Catastrophic metacarpal fractures occurred in racehorses with bilateral evidence of preexisting bone injury.

  6. Interventional Radiology in Paediatrics.

    Science.gov (United States)

    Chippington, Samantha J; Goodwin, Susie J

    2015-01-01

    As in adult practice, there is a growing role for paediatric interventional radiology expertise in the management of paediatric pathologies. This review is targeted for clinicians who may refer their patients to paediatric interventional radiology services, or who are responsible for patients who are undergoing paediatric interventional radiology procedures. The article includes a brief overview of the indications for intervention, techniques involved and the commonest complications. Although some of the procedures described are most commonly performed in a tertiary paediatric centre, many are performed in most Children's hospitals.

  7. Medial Condyle Fracture (Kilfoyle Type III of the Distal Humerus with Transient Fishtail Deformity after Surgery

    Directory of Open Access Journals (Sweden)

    Motoki Sonohata

    2017-01-01

    Full Text Available A “Fishtail deformity” is one of the well-known complications following pediatric lateral condyle or supracondylar fractures of the humerus. We herein report a case of medial condyle fracture (Kilfoyle type III in an 11-year-old boy. He had a transient “fishtail deformity” of the trochlear groove after open reduction and internal fixation. As occurred in the current case, the bone remodeling and the improvement of ischemia of the trochlea after medial condyle fracture may be associated with the likelihood of recovery from transient “fishtail deformity.”

  8. Paediatrics: messages from Munich

    Directory of Open Access Journals (Sweden)

    Fabio Midulla

    2015-05-01

    Full Text Available The aim of this article is to describe paediatric highlights from the 2014 European Respiratory Society (ERS International Congress in Munich, Germany. Abstracts from the seven groups of the ERS Paediatric Assembly (Respiratory Physiology and Sleep, Asthma and Allergy, Cystic Fibrosis, Respiratory Infection and Immunology, Neonatology and Paediatric Intensive Care, Respiratory Epidemiology, and Bronchology are presented in the context of the current literature.

  9. Paediatric cervical spine injury but NEXUS negative

    OpenAIRE

    Maxwell, Melanie J; Jardine, Andrew D

    2007-01-01

    Cervical spine injuries in paediatric patients following trauma are extremely rare. The National Emergency X‐Radiography Utilization Study (NEXUS) guidelines are a set of clinical criteria used to guide physicians in identifying trauma patients requiring cervical spine imaging. It is validated for use in children. A case of a child who did not fulfil the NEXUS criteria for imaging but was found to have a cervical spine fracture is reported.

  10. Paediatric radiopharmaceutical administration

    DEFF Research Database (Denmark)

    Lassmann, Michael; Treves, S Ted; Borgwardt, Lise

    2014-01-01

    In 2008 the EANM published their paediatric dosage card. In 2011 the North American consensus guidelines recommended a set of administered activities for paediatric nuclear medicine. During the EANM congress in 2012 a working group of the EANM and the SNMMI met to study the possibility of harmoni...

  11. Safety in paediatric imaging

    International Nuclear Information System (INIS)

    Carter, D.; Filice, I.; Murray, D.; Thomas, K.

    2006-01-01

    Those of us working in a dedicated paediatric environment are aware of the important safety issues with regard to paediatrics. Our goal when working with paediatric patients, the goal is to obtain the best quality images while keeping patients safe and their distress to a minimum. This article will discuss some of the issues regarding paediatric safety in a diagnostic imaging department, including radiation doses and the risk to paediatric patients, reducing medication errors, safe sedation practice and environmental safety. Also discussed are some conditions requiring special consideration to maintain patient safety such as epiglottitis and suspected child abuse. Promotion of a patient/family-centered care system will create an environment of trust where parents or guardians will know that their children are being well cared for in a safe, effective environment. (author)

  12. Paediatric horse-related trauma.

    Science.gov (United States)

    Theodore, Jane E; Theodore, Sigrid G; Stockton, Kellie A; Kimble, Roy M

    2017-06-01

    This retrospective cohort study reported on the epidemiology of horse-related injuries for patients presenting to the only tertiary paediatric trauma hospital in Queensland. The secondary outcome was to examine the use of helmets and adult supervision. Traumatic brain injury (TBI) was examined in relation to helmet use. Morbidity and mortality were also recorded. Included were all patients presenting with any horse-related trauma to the Royal Children's Hospital in Brisbane from January 2008 to August 2014. Data were retrospectively collected on patient demographics, hospital length of stay (LOS), mechanism of injury (MOI), safety precautions taken, diagnoses and surgical procedures performed. Included in the analysis were 187 incidents involving 171 patients. Most patients were aged 12-14 years (36.9%) and female (84.5%). The most common MOI were falls while riding horses (97.1%). Mild TBI (24.6%) and upper limb fractures (20.9%) were common injuries sustained. Patients who wore helmets had significantly reduced hospital LOS and severity of TBI when compared with those who did not wear helmets (P horses, in addition to being a compulsory requirement whilst horse riding. Prompts in documentation may assist doctors to record the use of safety attire and adult supervision. This will allow future studies to further investigate these factors in relation to clinical outcomes. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

  13. Paediatric Malignancies | Joseph | African Journal of Paediatric ...

    African Journals Online (AJOL)

    malignancies. Other common malignancies included sarcomas 10(14.71%), neurofibromatosis 9(13.24%), nephroblastoma 8(11.77%), acute lymphoblastic leukaemia 5(7.35%) and retinoblastoma 4(5.88%). The less common paediatric malignancies were melanoma, invasive lobular breast carcinoma and squamous cell ...

  14. Paediatric Anxiety Disorders

    Directory of Open Access Journals (Sweden)

    Beena Johnson

    2017-07-01

    Full Text Available Anxiety disorders are highly prevalent among children and are associated with serious morbidity. Lifetime prevalence of paediatric anxiety disorders is about fifteen percent. Social phobia, generalized anxiety disorder and separation anxiety disorder are included in the triad of paediatric anxiety disorders. Specific phobia, obsessive compulsive disorder and post-traumatic stress disorder are also commonly seen in children. Overprotection by parents, parental death or separation, female sex, low educational status, family history of anxiety disorder, financial stress in family and adverse childhood experiences are risk factors for the development of anxiety disorders. If not diagnosed and managed at the earliest, paediatric anxiety disorders can cause life threatening problems in the future. Hence early and scientific management of anxiety disorders is essential. Cognitive behavioural therapy is the effective evidence based treatment for paediatric anxiety disorders.

  15. Paediatric interventional radiology

    African Journals Online (AJOL)

    2016-06-29

    Jun 29, 2016 ... Non-operative management is the standard of care in children with blunt solid ... treatment of choice in children with extensive deep venous ... thrombosis. An IVC .... children, a paediatric nurse comfortable with administering.

  16. Challenges in paediatric neurosurgery

    Directory of Open Access Journals (Sweden)

    Pragati Ganjoo

    2017-01-01

    Full Text Available Improvements in technique, knowledge and expertise have brought about rapid advances in the fields of paediatric neurosurgery and anaesthesia, and many procedures limited earlier to adults are now being increasingly attempted in neonates and small children, with good outcomes. This article highlights the challenges faced by the operating team while handling some of the technically complex procedures like awake craniotomy, interventional neuroradiology, minimally invasive neurosurgery, procedures in intraoperative magnetic resonance imaging suites, and neonatal emergencies in the paediatric population.

  17. Displaced fracture through the anterior atlantal synchondrosis

    International Nuclear Information System (INIS)

    Thakar, Chrishan; Allibone, James; Harish, Srinivasan; Saifuddin, Asif

    2005-01-01

    In the acute setting, accurate radiological interpretation of paediatric cervical spine trauma can be difficult due to a combination of normal variants and presence of multiple synchondroses. We present a rare case of a fracture through the anterior atlantal synchondrosis in a paediatric spine. A five-year-old boy, who fell backwards onto the top of his head while swinging across on a monkey bar frame, presented with neck pain, cervical muscle spasm and decreased right lateral rotation and extension of his neck. Computed tomography showed a displaced diastatic fracture through right anterior atlantal synchondrosis. There are only 12 cases of paediatric C1 fractures reported in the world literature. The importance of considering this diagnosis in the appropriate clinical setting, and the normal variants in the paediatric atlas that can cause diagnostic dilemma to the interpreting radiologist, are discussed in this case report. (orig.)

  18. Displaced fracture through the anterior atlantal synchondrosis

    Energy Technology Data Exchange (ETDEWEB)

    Thakar, Chrishan; Allibone, James [Royal National Orthopaedic Hospital NHS Trust, Department of Spinal Deformity, Stanmore, Middlesex (United Kingdom); Harish, Srinivasan [Royal National Orthopaedic Hospital NHS Trust, Department of Radiology, Stanmore, Middlesex (United Kingdom); Saifuddin, Asif [Royal National Orthopaedic Hospital NHS Trust, Department of Radiology, Stanmore, Middlesex (United Kingdom); University College, The Institute of Orthopaedics and Musculoskeletal Sciences, London (United Kingdom)

    2005-09-01

    In the acute setting, accurate radiological interpretation of paediatric cervical spine trauma can be difficult due to a combination of normal variants and presence of multiple synchondroses. We present a rare case of a fracture through the anterior atlantal synchondrosis in a paediatric spine. A five-year-old boy, who fell backwards onto the top of his head while swinging across on a monkey bar frame, presented with neck pain, cervical muscle spasm and decreased right lateral rotation and extension of his neck. Computed tomography showed a displaced diastatic fracture through right anterior atlantal synchondrosis. There are only 12 cases of paediatric C1 fractures reported in the world literature. The importance of considering this diagnosis in the appropriate clinical setting, and the normal variants in the paediatric atlas that can cause diagnostic dilemma to the interpreting radiologist, are discussed in this case report. (orig.)

  19. Dating fractures in infants

    Energy Technology Data Exchange (ETDEWEB)

    Halliday, K.E., E-mail: kath.halliday@nuh.nhs.uk [Department of Radiology, Nottingham University Hospitals, Queen' s Medical Centre, Nottingham (United Kingdom); Broderick, N J; Somers, J M [Department of Radiology, Nottingham University Hospitals, Queen' s Medical Centre, Nottingham (United Kingdom); Hawkes, R [Department of Radiology, Paul O' Gorman Building, Bristol (United Kingdom)

    2011-11-15

    Aim: To document the timing of the appearance of the radiological features of fracture healing in a group of infants in which the date of injury was known and to assess the degree of interobserver agreement. Materials and methods: Three paediatric radiologists independently assessed 161 images of 37 long bone fractures in 31 patients aged 0-44 months. The following features were assessed: soft-tissue swelling, subperiosteal new bone formation (SPNBF), definition of fracture line, presence or absence of callus, whether callus was well or ill defined, and the presence of endosteal callus. Results: Agreement between observers was only moderate for all discriminators except SPNBF. SPNBF was invariably seen after 11 days but was uncommon before this time even in the very young. In one case SPNBF was seen at 4 days. Conclusion: With the exception of SPNBF, the criteria relied on to date fractures are either not reproducible or are poor discriminators of fracture age.

  20. Dating fractures in infants

    International Nuclear Information System (INIS)

    Halliday, K.E.; Broderick, N.J.; Somers, J.M.; Hawkes, R.

    2011-01-01

    Aim: To document the timing of the appearance of the radiological features of fracture healing in a group of infants in which the date of injury was known and to assess the degree of interobserver agreement. Materials and methods: Three paediatric radiologists independently assessed 161 images of 37 long bone fractures in 31 patients aged 0-44 months. The following features were assessed: soft-tissue swelling, subperiosteal new bone formation (SPNBF), definition of fracture line, presence or absence of callus, whether callus was well or ill defined, and the presence of endosteal callus. Results: Agreement between observers was only moderate for all discriminators except SPNBF. SPNBF was invariably seen after 11 days but was uncommon before this time even in the very young. In one case SPNBF was seen at 4 days. Conclusion: With the exception of SPNBF, the criteria relied on to date fractures are either not reproducible or are poor discriminators of fracture age.

  1. Malnutrition in paediatric oncology patients

    African Journals Online (AJOL)

    Nutritional status of paediatric cancer patients at diagnosis ... Professor and Executive Head, Department of Paediatrics and Child Health, Stellenbosch University and Tygerberg Hospital, .... can lead to decreased oral intake, weight loss.

  2. Genodermatoses in paediatric age group

    Directory of Open Access Journals (Sweden)

    Kumar Sunil

    1996-01-01

    Full Text Available Pattern of genodermatoses in paediatric age group was studied. The relative incidence of genodermatoses in paediatric dermatology out patient department was 0.62%. The commonest genodermatoses observed was ichthyosis.

  3. Drugs for the paediatric heart

    African Journals Online (AJOL)

    Head, Paediatric Cardiology Service of the Western Cape, Department of Paediatrics and Child Health, ... His interests also include the care of complex patients ... The pharmacy only has enalapril available – can you substitute this drug for the ...

  4. African Journal of Paediatric Surgery

    African Journals Online (AJOL)

    The African Journal of Paediatric Surgery aims to promote research, post- graduate training and further education among Paediatric surgeons, Paediatric Surgical Trainees and paramedical personnel in the surgery of newborn infants and children particularly in Africa and other tropical regions of the world.AJPS welcomes ...

  5. African Journal of Paediatric Nephrology

    African Journals Online (AJOL)

    African Journal of Paediatric Nephrology is the official Journal of the African Paediatric Nephrology Association (AFPNA). The journal is dedicated to increasing awareness and knowledge of Paediatric nephrology in Africa and beyond. We publish research articles on renal diseases in children, on fluid and electrolyte ...

  6. Paediatric interventional radiology

    International Nuclear Information System (INIS)

    McLaren, Clare

    2014-01-01

    Paediatric interventional radiology (PIR) is a rapidly-growing subspecialty, which offers a wide range of procedures applicable to almost all areas of hospital paediatrics. There are many important differences between paediatric and adult practice in interventional radiology, including disease processes and treatment goals, anatomical considerations, periprocedural patient management, radiation exposure optimisation and legal aspects. The use of retrievable or absorbable interventional devices such as stents will probably become more widespread in PIR practice. Recent advances in the technology of imaging equipment have been accompanied by an increase in the complexity of the work done by the radiographer. These developments present challenges and opportunities related to training and maintenance of skills, staffing arrangements, and the potential for advanced practice. It is likely that specialisation in PIR will become a more common role for radiographers in the future

  7. Paediatric airway management: basic aspects

    DEFF Research Database (Denmark)

    Holm-Knudsen, R J; Rasmussen, L S

    2009-01-01

    Paediatric airway management is a great challenge, especially for anaesthesiologists working in departments with a low number of paediatric surgical procedures. The paediatric airway is substantially different from the adult airway and obstruction leads to rapid desaturation in infants and small...... children. This paper aims at providing the non-paediatric anaesthesiologist with a set of safe and simple principles for basic paediatric airway management. In contrast to adults, most children with difficult airways are recognised before induction of anaesthesia but problems may arise in all children...

  8. Pathological fractures in children

    Science.gov (United States)

    De Mattos, C. B. R.; Binitie, O.; Dormans, J. P.

    2012-01-01

    Pathological fractures in children can occur as a result of a variety of conditions, ranging from metabolic diseases and infection to tumours. Fractures through benign and malignant bone tumours should be recognised and managed appropriately by the treating orthopaedic surgeon. The most common benign bone tumours that cause pathological fractures in children are unicameral bone cysts, aneurysmal bone cysts, non-ossifying fibromas and fibrous dysplasia. Although pathological fractures through a primary bone malignancy are rare, these should be recognised quickly in order to achieve better outcomes. A thorough history, physical examination and review of plain radiographs are crucial to determine the cause and guide treatment. In most benign cases the fracture will heal and the lesion can be addressed at the time of the fracture, or after the fracture is healed. A step-wise and multidisciplinary approach is necessary in caring for paediatric patients with malignancies. Pathological fractures do not have to be treated by amputation; these fractures can heal and limb salvage can be performed when indicated. PMID:23610658

  9. Fracture of the Atlas through a Synchondrosis of Anterior Arch

    Directory of Open Access Journals (Sweden)

    Gamze Turk

    2013-01-01

    Full Text Available Cervical fractures are rare in paediatric population. In younger children, cervical fractures usually occur above the level of C4; whereas in older population, fractures or dislocations more commonly involve the lower cervical spine. Greater elasticity of intervertebral ligaments and also the spinal vertebrae explains why cervical fractures in paediatric ages are rare. The injury usually results from a symmetric or asymmetric axial loading. In paediatric cases, most fractures occur through the synchondroses which are the weakest links of the atlas. The prognosis depends on the severity of the spinal cord injury. In this case, we presented an anterior fracture in synchondrosis of atlas after falling on head treated with cervical collar. There was no neurologic deficit for the following 2 years.

  10. Ipsilateral Femoral Fracture Non-Union and Delayed Union Treated By Hybrid Plate Nail Fixation and Vascularized Fibula Bone Grafting: A Case Report

    Directory of Open Access Journals (Sweden)

    CK Chan

    2013-07-01

    Full Text Available Non-union is a well recognized complication of femoral neck fractures. The decision whether to attempt fracture fixation or to resort to hip replacement is particularly difficult in patients in the borderline age group in whom complex attempts at gaining union may fail and later present a difficult revision. On the other hand the patient may be young enough that arthroplasty best be avoided . Besides, presence of ipsilateral femoral shaft fracture with delayed union in addition to the femoral neck non-union will pose major problems at operation. We share our experience in treating a femoral neck fracture non-union with ipsilateral femoral shaft delayed union in the shaft and in the distal femur in a fifty years old patient. The fracture was treated with an angle blade plate and supracondylar nail supplemented with a free vascularised fibular bone grafting and autologous cancellous graft. There was radiological union at fourth month. At sixth months, the patient was free of pain and able to walk without support. Thus, we would like to suggest that vascularised fibula bone grafting with supracondylar nailing is a viable option for this pattern of fracture.

  11. Prosthetics in Paediatric Dentistry

    Directory of Open Access Journals (Sweden)

    Vulićević Zoran

    2017-07-01

    Full Text Available Premature loss of teeth in children may lead to both functional and esthetic problems. Missing teeth in both anterior and posterior regions may cause malfunctions in mastication and proper pronunciation. If the missing teeth are not replaced, further complications may occur, including adjacent tooth migration, loss of alveolar bone, and irregular occlusion. Considering the sensitive nature of children, loss of teeth may cause the development of insecurities and low self esteem problems. Due to dynamic nature of growth in children and adolescents, prosthetic appliances must not hinder development of orofacial system, and must meet adequate esthetic and functional standards. Dental prosthetic appliances in paediatrics must be planned with respect to the special conditions that led to tooth loss or damage. Multi-disciplinary approach is needed, under constant supervision of paediatric dentist and orthodontist, as well as regular checkups with clinical and radiographical examinations.

  12. Paediatric treadmill friction injuries.

    Science.gov (United States)

    Jeremijenko, Luke; Mott, Jonathan; Wallis, Belinda; Kimble, Roy

    2009-05-01

    The aim of this study was to report on the severity and incidence of children injured by treadmills and to promote the implementation of safety standards. This retrospective review of children with treadmill friction injuries was conducted in a single tertiary-level burns centre in Australia between January 1997 and June 2007. The study revealed 37 children who sustained paediatric treadmill friction injuries. This was a presentation of 1% of all burns. Thirty-three (90%) of the injuries occurred in the last 3.5 years (January 2004 to June 2007). The modal age was 3.2 years. Thirty-three (90%) injuries were either full thickness or deep partial friction burns. Eleven (30%) required split thickness skin grafts. Of those who became entrapped, 100% required skin grafting. This study found that paediatric treadmill friction injuries are severe and increasing in incidence. Australian standards should be developed, implemented and mandated to reduce this preventable and severe injury.

  13. Litigation in paediatrics

    LENUS (Irish Health Repository)

    Murphu, JFA

    2011-03-01

    on the issue. This is understandable. Most individuals are healthy during their childhood and have less need of and less interaction with medical services when compared with adults. However, Paediatric litigation does happen and furthermore it is likely to increase in parallel with other specialties. Carroll and Buddenbaum1 have described the pattern of Paediatric litigation in the US. The annual incidence of malpractice claims has been quoted to be as high as 6.6 claims per 100 Paediatricians per year. Almost 30% of Paediatricians have been sued with many being sued on more than one occasion. Of these cases 36% were settled out of court, 33% were dropped by the plaintiff with the remainder going before the judiciary. The authors point out that in the US medical malpractice is a hotly debated issue. Litigation has a questionable impact on health care quality, cost, and access to services. The AMA believes that rising premiums are resulting in the curtailment of medical care particularly in states with high medico-legal rates. The Physician Insurers Association of America (PIAA) is a trade organisation which insures 60% of all private practicing physicians and surgeons has been a useful source of data. In the 20 year period 1985-2005 among a total of 214,226 claims there were 6363 (2.9%) Paediatric claims which ranked it 10th among the 28 specialties covered. The claims arose in equal numbers from the hospital and Paediatrician’s office settings. Common reasons for Paediatric litigation were errors in diagnosis (32%), incorrect performance of a medical or surgical procedure (13%), failure to monitor or manage a case effectively (10%) and medication error (5%). The top five medico-legal conditions were meningitis, routine infant or child checks, newborn respiratory problems, appendicitis and brain-damaged infants as a co-defendant with Obstetrics. Good quality information about litigation is important because the discussion among doctors is frequently confused by

  14. Renal imaging in paediatrics

    International Nuclear Information System (INIS)

    Porn, U.; Hahn, K.; Fischer, S.

    2003-01-01

    The most frequent renal diseases in paediatrics include urinary tract infections, hydronephrosis, kidney anomalies and reflux. The main reason for performing DMSA scintigraphy in paediatrics is the detection of cortical abnormalities related to urinary tract infection. Because the amount of tracer retained in the tubular cells is associated with the distribution of functioning renal parenchyma in the kidney, it is possible, to evaluate the split renal function. In comparison to ultrasound and intravenous urography the sensitivity in the detection of acute as well as chronic inflammatory changes is very high, however less specific. An indication for a renography in neonates and children is beside an estimation of the total renal function and the calculation of the split renal function, the assessment of renal drainage in patients with unclear dilatation of the collecting system in ultrasound. The analysis of the time activity curve provides, especially for follow-up studies, a reproducible method to assess the urinary outflow. The diuretic scintigraphy allows the detection of urinary obstruction. Subsequently it is possible to image the micturition phase to detect vesico-ureteric reflux (indirect MCU) after drainage of tracer from the renal pelvis. An reflux in the ureters or the pelvicalyceal system is visible on the scintigraphic images and can be confirmed by time activity curves. A more invasive technique is the direct isotope cystography with bladder catheterization. The present paper should give an overview about the role of nuclear medicine in paediatric urology. (orig.) [de

  15. Fracture Mechanics

    International Nuclear Information System (INIS)

    Jang, Dong Il; Jeong, Gyeong Seop; Han, Min Gu

    1992-08-01

    This book introduces basic theory and analytical solution of fracture mechanics, linear fracture mechanics, non-linear fracture mechanics, dynamic fracture mechanics, environmental fracture and fatigue fracture, application on design fracture mechanics, application on analysis of structural safety, engineering approach method on fracture mechanics, stochastic fracture mechanics, numerical analysis code and fracture toughness test and fracture toughness data. It gives descriptions of fracture mechanics to theory and analysis from application of engineering.

  16. Paediatric post-traumatic cortical defects of the distal radius

    International Nuclear Information System (INIS)

    Roach, Richard T.; Summers, Bruce N.; Cassar-Pullicino, Victor

    2002-01-01

    Paediatric post-traumatic cortical defects, although rare, are predominately seen affecting the distal radius following a greenstick or torus fracture. We review the literature and present a further two cases supported by CT and MRI. Images from an acute greenstick fracture are also presented to help understand the pathogenesis. Defects are typically solitary on plain radiographs and are usually noticed late, proximal to the site of compression. They are non-expansile in an otherwise healthy child. CT and MRI may reveal smaller multiple subperiosteal defects. Typical defects require no further management other than reassurance and advice that they may occasionally cause discomfort but resolve with time. (orig.)

  17. Metastatic paediatric colorectal carcinoma.

    LENUS (Irish Health Repository)

    Woods, R

    2012-03-01

    A 16-year-old girl presented to our unit with crampy abdominal pain, change in bowel habit, a subjective impression of weight loss and a single episode of haematochezia. She was found to have a rectosigmoid adenocarcinoma and proceeded to laparoscopic anterior resection, whereupon peritoneal metastases were discovered. She received chemotherapy and is alive and well ten month later with no radiological evidence of disease. Colorectal carcinoma is rare in the paediatric population but is increasing in incidence. Early diagnosis is critical to enable optimal outcomes.

  18. Paediatric nuclear medicine

    Energy Technology Data Exchange (ETDEWEB)

    Da Costa, H [Bhabha Atomic Research Centre, Bombay (India). Radiation Medicine Centre

    1978-05-01

    The use of radiopharmaceutical agents for the diagnosis of diseases frequently encountered in the paediatric age group is outlined. The agents suitable for scanning of brain, thyroid, kidney, liver and spleen are mentioned and their efficacy in diagnosis of pathological conditions based on practical experience is reported. Bromide partition test for diagnosis of intracranial tuberculosis and /sup 131/I uptake test for thyroid study are also described. Dose of the agent is smaller than that in the case of adults and depends upon the child's body weight.

  19. The paediatric Bohler's angle and crucial angle of Gissane: a case series

    Directory of Open Access Journals (Sweden)

    Crawford Haemish A

    2011-01-01

    Full Text Available Abstract Background Bohler's angle and the crucial angle of Gissane can be used to assess calcaneal fractures. While the normal adult values of these angles are widely known, the normal paediatric values have not yet been established. Our aim is to investigate Bohler's angle and the crucial angle of Gissane in a paediatric population and establish normal paediatric reference values. Method We measured Bohler's angle and the crucial angle of Gissane using normal plain ankle radiographs of 763 patients from birth to 14 years of age completed over a five year period from July 2003 to June 2008. Results In our paediatric study group, the mean Bohler's angle was 35.2 degrees and the mean crucial angle of Gissane was 111.3 degrees. In an adult comparison group, the mean Bohler's angle was 39.2 degrees and the mean crucial angle of Gissane was 113.8 degrees. The differences in Bohler's angle and the crucial angle of Gissane between these two groups were statistically significant. Conclusion We have presented the normal values of Bohler's angle and the crucial angle of Gissane in a paediatric population. These values may provide a useful comparison to assist with the management of the paediatric calcaneal fracture.

  20. Acute paediatric ankle trauma: MRI versus plain radiography

    Energy Technology Data Exchange (ETDEWEB)

    Lohman, M. [Helsinki Univ. Central Hospital (Finland). Dept. of Radiology; Radiological Dept., Helsinki University Central Hospital (Finland); Kivisaari, A.; Kivisaari, L. [Helsinki Univ. Central Hospital (Finland). Dept. of Radiology; Kallio, P.; Puntila, J. [Dept. of Paediatric Surgery, Hospital for Children and Adolescents, Helsinki Univ. Central Hospital, Helsinki (Finland); Vehmas, T. [Finnish Institute of Occupational Health, Helsinki (Finland)

    2001-09-01

    Objective: To evaluate the diagnosis of acute physeal ankle fractures on plain radiographs using MRI as the gold standard. Methods: Sixty consecutive children, 29 with a clinical diagnosis of lateral ligament injury and 31 with physeal ankle fractures, were examined using both radiographs and MRI in the acute period. The imaging data were reviewed by three ''masked'' radiologists. The fracture diagnosis and Slater-Harris classification of radiographs were compared with findings on MRI. Results: Plain radiography produced five of 28 (18%) false negative and 12 of 92 (13%) false positive fracture diagnoses compared with MRI. Six of the 12 false positive fractures were due to a misclassification of lateral ligament disruption as SH1 fractures. Altogether a difference was found in 21% of cases in either the diagnosis or the classification of the fractures according to Salter- Harris. All bone bruises in the distal tibia and fibula and 64% of bone bruises in the talus were seen in association with lateral ligament injuries. Talar bone bruises in association with fractures occurred on the same side as the malleolar fracture; talar bone bruises in association with lateral ligament disruption were seen in different locations. The errors identified on radiographs by MRI did not affect the management of the injury. Conclusions: The incidence of false negative ankle fractures in plain radiographs was small and no complex ankle fractures were missed on radiographs. The total extent of complex fractures was, however, not always obvious on radiographs. In an unselected series of relatively mild ankle injuries, we were unable to show a single case where the treatment or prognosis based on plain radiography should have been significantly altered after having done a routine MRI examination. Plain radiography is still the diagnostic cornerstone of paediatric ankle injuries. (orig.)

  1. Acute paediatric ankle trauma: MRI versus plain radiography

    International Nuclear Information System (INIS)

    Lohman, M.; Kivisaari, A.; Kivisaari, L.; Vehmas, T.

    2001-01-01

    Objective: To evaluate the diagnosis of acute physeal ankle fractures on plain radiographs using MRI as the gold standard. Methods: Sixty consecutive children, 29 with a clinical diagnosis of lateral ligament injury and 31 with physeal ankle fractures, were examined using both radiographs and MRI in the acute period. The imaging data were reviewed by three ''masked'' radiologists. The fracture diagnosis and Slater-Harris classification of radiographs were compared with findings on MRI. Results: Plain radiography produced five of 28 (18%) false negative and 12 of 92 (13%) false positive fracture diagnoses compared with MRI. Six of the 12 false positive fractures were due to a misclassification of lateral ligament disruption as SH1 fractures. Altogether a difference was found in 21% of cases in either the diagnosis or the classification of the fractures according to Salter- Harris. All bone bruises in the distal tibia and fibula and 64% of bone bruises in the talus were seen in association with lateral ligament injuries. Talar bone bruises in association with fractures occurred on the same side as the malleolar fracture; talar bone bruises in association with lateral ligament disruption were seen in different locations. The errors identified on radiographs by MRI did not affect the management of the injury. Conclusions: The incidence of false negative ankle fractures in plain radiographs was small and no complex ankle fractures were missed on radiographs. The total extent of complex fractures was, however, not always obvious on radiographs. In an unselected series of relatively mild ankle injuries, we were unable to show a single case where the treatment or prognosis based on plain radiography should have been significantly altered after having done a routine MRI examination. Plain radiography is still the diagnostic cornerstone of paediatric ankle injuries. (orig.)

  2. The imaging of paediatric thoracic trauma

    Energy Technology Data Exchange (ETDEWEB)

    Moore, Michael A.; Westra, Sjirk J. [Massachusetts General Hospital and Harvard Medical School, Department of Radiology, Boston, MA (United States); Wallace, E.C. [UMass Memorial Medical Center and University of Massachusetts Medical School, Department of Radiology, Worcester, MA (United States)

    2009-05-15

    Major chest trauma in a child is associated with significant morbidity and mortality. It is most frequently encountered within the context of multisystem injury following high-energy trauma such as a motor vehicle accident. The anatomic-physiologic make-up of children is such that the pattern of ensuing injuries differs from that in their adult counterparts. Pulmonary contusion, pneumothorax, haemothorax and rib fractures are most commonly encountered. Although clinically more serious and potentially life threatening, tracheobronchial tear, aortic rupture and cardiac injuries are seldom observed. The most appropriate imaging algorithm is one tailored to the individual child and is guided by the nature of the traumatic event as well as clinical parameters. Chest radiography remains the first and most important imaging tool in paediatric chest trauma and should be supplemented with US and CT as indicated. Multidetector CT allows for the accurate diagnosis of most traumatic injuries, but should be only used in selected cases as its routine use in all paediatric patients would result in an unacceptably high radiation exposure to a large number of patients without proven clinical benefit. When CT is used, appropriate modifications should be incorporated so as to minimize the radiation dose to the patient whilst preserving diagnostic integrity. (orig.)

  3. The imaging of paediatric thoracic trauma

    International Nuclear Information System (INIS)

    Moore, Michael A.; Westra, Sjirk J.; Wallace, E.C.

    2009-01-01

    Major chest trauma in a child is associated with significant morbidity and mortality. It is most frequently encountered within the context of multisystem injury following high-energy trauma such as a motor vehicle accident. The anatomic-physiologic make-up of children is such that the pattern of ensuing injuries differs from that in their adult counterparts. Pulmonary contusion, pneumothorax, haemothorax and rib fractures are most commonly encountered. Although clinically more serious and potentially life threatening, tracheobronchial tear, aortic rupture and cardiac injuries are seldom observed. The most appropriate imaging algorithm is one tailored to the individual child and is guided by the nature of the traumatic event as well as clinical parameters. Chest radiography remains the first and most important imaging tool in paediatric chest trauma and should be supplemented with US and CT as indicated. Multidetector CT allows for the accurate diagnosis of most traumatic injuries, but should be only used in selected cases as its routine use in all paediatric patients would result in an unacceptably high radiation exposure to a large number of patients without proven clinical benefit. When CT is used, appropriate modifications should be incorporated so as to minimize the radiation dose to the patient whilst preserving diagnostic integrity. (orig.)

  4. A FUNCTIONAL EVALUATION STUDY OF DISTAL FEMORAL FRACTURES FIXED WITH DISTAL FEMORAL LOCKING PLATE

    Directory of Open Access Journals (Sweden)

    Manikumar C. J

    2017-04-01

    Full Text Available BACKGROUND Fractures of the distal femur present considerable challenges in management. Older patients especially women sustain fractures due to osteoporosis. Supracondylar fractures of femur have a bimodal distribution. They account for 6% of all femur fractures and 31% if hip fractures were excluded. Nearly, 50% of distal femur intra-articular fractures are open fractures. Before 1970, most supracondylar fractures were treated nonoperatively; however, difficulties were often encountered including persistent angulatory deformity, knee joint incongruity, loss of knee motion and delayed mobilisation. The trend of open reduction and internal fixation has become evident in recent years with good results being obtained with AO blade plate, dynamic condylar screw, intramedullary supracondylar nail and locking compression plate. Elderly patients and osteoporosis pose difficulty in treating intra-articular fractures of the lower end of femur. Loss of stable fixation is of great concern in these cases. Hence, locking compression plate use has an advantage in these patients. MATERIALS AND METHODS In this study, 20 patients with closed fracture of distal femur were studied. All the cases were treated at the Department of Orthopaedics, Rangaraya Medical College/Government General Hospital, Kakinada, Andhra Pradesh, between November 2013 and November 2015. The method used for fracture fixation was open reduction and internal fixation with distal femoral locking plate. The duration of follow up ranged from 3 months to 24 months. All the fractures in this series were posttraumatic. The patients were functionally evaluated with Neer’s scoring system. 1 RESULTS Twenty distal femoral fractures were treated with distal femoral locking plates. 15 patients were males and 5 patients were females. The median age was 47 years ranging from 28-70 years. 16 of the fractures were caused by road traffic accidents and 2 were due to fall, 2 were due to assault. 12 patients

  5. Paediatric nuclear medicine imaging.

    Science.gov (United States)

    Biassoni, Lorenzo; Easty, Marina

    2017-09-01

    Nuclear medicine imaging explores tissue viability and function by using radiotracers that are taken up at cellular level with different mechanism. This imaging technique can also be used to assess blood flow and transit through tubular organs. Nuclear medicine imaging has been used in paediatrics for decades and this field is continuously evolving. The data presented comes from clinical experience and some milestone papers on the subject. Nuclear medicine imaging is well-established in paediatric nephro-urology in the context of urinary tract infection, ante-natally diagnosed hydronephrosis and other congenital renal anomalies. Also, in paediatric oncology, I-123-meta-iodobenzyl-guanidine has a key role in the management of children with neuroblastic tumours. Bone scintigraphy is still highly valuable to localize the source of symptoms in children and adolescents with bone pain when other imaging techniques have failed. Thyroid scintigraphy in neonates with congenital hypothyroidism is the most accurate imaging technique to confirm the presence of ectopic functioning thyroid tissue. Radionuclide transit studies of the gastro-intestinal tract are potentially useful in suspected gastroparesis or small bowel or colonic dysmotility. However, until now a standardized protocol and a validated normal range have not been agreed, and more work is necessary. Research is ongoing on whether magnetic resonance imaging (MRI), with its great advantage of great anatomical detail and no ionizing radiations, can replace nuclear medicine imaging in some clinical context. On the other hand, access to MRI is often difficult in many district general hospitals and general anaesthesia is frequently required, thus adding to the complexity of the examination. Patients with bone pain and no cause for it demonstrated on MRI can benefit from bone scintigraphy with single photon emission tomography and low-dose computed tomography. This technique can identify areas of mechanical stress at

  6. The development of paediatric neuroradiology

    International Nuclear Information System (INIS)

    Harwood-Nash, D.C.

    1978-01-01

    The development of paediatric neuroradiology is a specific persuasion within neuroradiology and has increased in scope and significance throughout the last ten years. The emergence of computed tomography has altered the indications for types of neuroradiological procedures in infants and children. The sophistication, accuracy, and safety of standard neuroradiological procedures have been increased by the accuracy and safety of computed tomography, particularly in the premature infant. There is a growing need for education and instruction in paediatric neuroradiological techniques and paediatric neuroradiological diseases within the neuroradiological fraternity as a whole. (orig.) [de

  7. Cuffed endotracheal tubes in paediatrics

    African Journals Online (AJOL)

    cuffed endotracheal tubes (CETTs) in children who are younger than eight years old. Most paediatric ... the smallest functional part of the infant airway, because the ... During the 2003 severe acute respiratory syndrome (SARS) outbreak in ...

  8. Patient exposure in paediatric radiology

    International Nuclear Information System (INIS)

    Iacob, O.; Diaconescu, C.; Isac, R.

    2002-01-01

    Because of their longer life expectancy, the risk of late manifestations of detrimental radiation effects is greater in children than in adults and, consequently, paediatric radiology gives ground for more concern regarding radiation protection than radiology of adults. The purpose of our study was to assess, in terms of effective dose, the magnitude of paediatric patient exposure during conventional X-ray examinations, selected for their high frequency or their relatively high doses delivered to patient

  9. Paediatric acute care: Highlights from the Paediatric Acute Care-Advanced Paediatric Life Support Conference, Gold Coast, 2017.

    Science.gov (United States)

    Teo, Stephen Ss; Rao, Arjun; Acworth, Jason

    2018-04-25

    The Paediatric Acute Care Conference is an annual conference organised by APLS Australia to advance paediatric acute care topics for clinicians in pre-hospital medicine, EDs, acute paediatrics, intensive care and anaesthesia. The Conference 2017 was held at Surfers Paradise, Queensland. We provide a summary of some of the presentations. © 2018 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  10. Teleradiology for remote consultation using iPad improves the use of health system human resources for paediatric fractures: prospective controlled study in a tertiary care hospital in Italy.

    Science.gov (United States)

    Zennaro, Floriana; Grosso, Daniele; Fascetta, Riccardo; Marini, Marta; Odoni, Luca; Di Carlo, Valentina; Dibello, Daniela; Vittoria, Francesca; Lazzerini, Marzia

    2014-07-28

    The growing cost of health care and lack of specialised staff have set e-Health high on the European political agenda. In a prospective study we evaluated the effect of providing images for remote consultation through an iPad on the number of in-hospital orthopaedic consultations for children with bone fractures. Children from 0 to 18 years diagnosed with a bone fracture by the radiologist during the hours when an orthopaedic service is provided only on-call were eligible for enrollment. Cases were enrolled prospectively during September and October 2013. A standard approach (verbal information only, no X-Ray provided remotely) was compared to an experimental approach (standard approach plus the provision of X-ray for remote consultation through an iPad). The primary outcome was the number of orthopaedic in-hospital consultations that occurred. Other outcomes included: immediate activation of other services; time needed for decision-making; technical difficulties; quality of images and diagnostic confidence (on a likert scale of 1 to 10). Forty-two children were enrolled in the study. Number of in-hospital consultancies dropped from 32/42 (76.1%) when no X-ray was provided to 16/42 (38%) when the X-rays was provided (p iPad and on the standard system for X- Ray visualisation resulted in a non statistically significant difference in the quality of images (average score 9.89 ± 0.37 vs 9.91 ± 0.30; p = 0.79), and in non statistically significant difference in diagnostic confidence (average score 9.91 ± 0.32 vs 9.92 ± 0.31; p = 0.88). Remote X-ray consultation through Aycan OsiriX PRO and iPad should be considered as a means for reducing the need of in-hospital orthopaedic consultation during on-call times, and potentially decrease the cost of care for the health system. In the future, alternative systems less expensive than Aycan OsiriX PRO should be further developed and tested.

  11. Nigerian Journal of Paediatrics: Editorial Policies

    African Journals Online (AJOL)

    Dr. Austine I Omoigberale FWACP (Paed) Professor of Paediatrics, Neonatology & Infectious diseases. Dept of Child Health University of Benin Teaching Hospital Benin City Nigeria isigboge@gmail.com +2348030750641. Dr. Felix Akinbami FWACP (Paed) Professor of Paediatrics & Gastroenterology Dept of Paediatrics

  12. Anaesthesia for paediatric patients: Minimising the risk

    African Journals Online (AJOL)

    to paediatric patients need to be offset against the need for optimal utilisation of national ... Risk stratification of paediatric patients for specific procedures in ... support colleagues in smaller district hospitals by means of telephonic advice, the ... techniques that can minimise risk in the paediatric surgical population. S Afr Med ...

  13. Fishtail deformity - a delayed complication of distal humeral fractures in children

    Energy Technology Data Exchange (ETDEWEB)

    Narayanan, Srikala [Massachusetts General Hospital, Department of Radiology, Division of Pediatric Imaging, Boston, MA (United States); University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA (United States); Shailam, Randheer; Nimkin, Katherine [Massachusetts General Hospital, Department of Radiology, Division of Pediatric Imaging, Boston, MA (United States); Grottkau, Brian E. [Massachusetts General Hospital, Department of Orthopaedics, Pediatric Orthopaedics, Boston, MA (United States)

    2015-06-15

    Concavity in the central portion of the distal humerus is referred to as fishtail deformity. This entity is a rare complication of distal humeral fractures in children. The purpose of this study is to describe imaging features of post-traumatic fishtail deformity and discuss the pathophysiology. We conducted a retrospective analysis of seven cases of fishtail deformity after distal humeral fractures. Seven children ages 7-14 years (five boys, two girls) presented with elbow pain and history of distal humeral fracture. Four of the seven children had limited range of motion. Five children had prior grade 3 supracondylar fracture treated with closed reduction and percutaneous pinning. One child had a medial condylar fracture and another had a lateral condylar fracture; both had been treated with conservative casting. All children had radiographs, five had CT and three had MRI. All children had a concave central defect in the distal humerus. Other imaging features included joint space narrowing with osteophytes and subchondral cystic changes in four children, synovitis in one, hypertrophy or subluxation of the radial head in three and proximal migration of the ulna in two. Fishtail deformity of the distal humerus is a rare complication of distal humeral fractures in children. This entity is infrequently reported in the radiology literature. Awareness of the classic imaging features can result in earlier diagnosis and appropriate treatment. (orig.)

  14. Fishtail deformity - a delayed complication of distal humeral fractures in children

    International Nuclear Information System (INIS)

    Narayanan, Srikala; Shailam, Randheer; Nimkin, Katherine; Grottkau, Brian E.

    2015-01-01

    Concavity in the central portion of the distal humerus is referred to as fishtail deformity. This entity is a rare complication of distal humeral fractures in children. The purpose of this study is to describe imaging features of post-traumatic fishtail deformity and discuss the pathophysiology. We conducted a retrospective analysis of seven cases of fishtail deformity after distal humeral fractures. Seven children ages 7-14 years (five boys, two girls) presented with elbow pain and history of distal humeral fracture. Four of the seven children had limited range of motion. Five children had prior grade 3 supracondylar fracture treated with closed reduction and percutaneous pinning. One child had a medial condylar fracture and another had a lateral condylar fracture; both had been treated with conservative casting. All children had radiographs, five had CT and three had MRI. All children had a concave central defect in the distal humerus. Other imaging features included joint space narrowing with osteophytes and subchondral cystic changes in four children, synovitis in one, hypertrophy or subluxation of the radial head in three and proximal migration of the ulna in two. Fishtail deformity of the distal humerus is a rare complication of distal humeral fractures in children. This entity is infrequently reported in the radiology literature. Awareness of the classic imaging features can result in earlier diagnosis and appropriate treatment. (orig.)

  15. Paediatric and adult malignant glioma

    DEFF Research Database (Denmark)

    Jones, Chris; Perryman, Lara; Hargrave, Darren

    2012-01-01

    Gliomas in children differ from their adult counterparts by their distribution of histological grade, site of presentation and rate of malignant transformation. Although rare in the paediatric population, patients with high-grade gliomas have, for the most part, a comparably dismal clinical outcome...... to older patients with morphologically similar lesions. Molecular profiling data have begun to reveal the major genetic alterations underpinning these malignant tumours in children. Indeed, the accumulation of large datasets on adult high-grade glioma has revealed key biological differences between...... the adult and paediatric disease. Furthermore, subclassifications within the childhood age group can be made depending on age at diagnosis and tumour site. However, challenges remain on how to reconcile clinical data from adult patients to tailor novel treatment strategies specifically for paediatric...

  16. Effective doses in paediatric radiology

    International Nuclear Information System (INIS)

    Iacob, Olga; Diaconescu, Cornelia; Roca, Antoaneta

    2001-01-01

    Because of their longer life expectancy, the risk of late manifestations of detrimental radiation effects is greater in children than in adults and, consequently, paediatric radiology gives ground for more concern regarding radiation protection than radiology of adults. The purpose of our study is to assess in terms of effective doses the magnitude of paediatric patient exposure during conventional X-ray examinations, selected for their high frequency or their relatively high doses to the patient. Effective doses have been derived from measurements of dose-area product (DAP) carried out on over 900 patients undergoing X-ray examinations, in five paediatric units. The conversion coefficients for estimating effective doses are those calculated by the NRPB using Monte-Carlo technique on a series of 5 mathematical phantoms representing 0, 1, 5, 10 and 15 year old children. The annual frequency of X-ray examinations necessary for collective dose calculation are those reported in our last national study on medical exposure, conducted in 1995. The annual effective doses from all medical examinations for the average paediatric patient are as follows: 1.05 mSv for 0 year old, 0.98 mSv for 1 year old, 0.53 mSv for 5 year old, 0.65 mSv for 10 year old and 0.70 mSv for 15 year old. The resulting annual collective effective dose was evaluated at 625 man Sv with the largest contribution of pelvis and hip examinations (34%). The annual collective effective associated with paediatric radiology in Romania represent 5% of the annual value resulting from all diagnostic radiology. Examination of the chest is by far the most frequent procedure for children, accounting for about 60 per cent of all annually performed X-ray conventional examinations. Knowledge of real level of patient dose is an essential component of quality assurance programs in paediatric radiology. (authors)

  17. Singapore Paediatric Resuscitation Guidelines 2016.

    Science.gov (United States)

    Ong, Gene Yong Kwang; Chan, Irene Lai Yeen; Ng, Agnes Suah Bwee; Chew, Su Yah; Mok, Yee Hui; Chan, Yoke Hwee; Ong, Jacqueline Soo May; Ganapathy, Sashikumar; Ng, Kee Chong

    2017-07-01

    We present the revised 2016 Singapore paediatric resuscitation guidelines. The International Liaison Committee on Resuscitation's Pediatric Taskforce Consensus Statements on Science and Treatment Recommendations, as well as the updated resuscitation guidelines from the American Heart Association and European Resuscitation Council released in October 2015, were debated and discussed by the workgroup. The final recommendations for the Singapore Paediatric Resuscitation Guidelines 2016 were derived after carefully reviewing the current available evidence in the literature and balancing it with local clinical practice. Copyright: © Singapore Medical Association.

  18. Autoimmune paediatric liver disease.

    Science.gov (United States)

    Mieli-Vergani, Giorgina; Vergani, Diego

    2008-06-07

    Liver disorders with a likely autoimmune pathogenesis in childhood include autoimmune hepatitis (AIH), autoimmune sclerosing cholangitis (ASC), and de novo AIH after liver transplantation. AIH is divided into two subtypes according to seropositivity for smooth muscle and/or antinuclear antibody (SMA/ANA, type 1) or liver kidney microsomal antibody (LKM1, type 2). There is a female predominance in both. LKM1 positive patients tend to present more acutely, at a younger age, and commonly have partial IgA deficiency, while duration of symptoms before diagnosis, clinical signs, family history of autoimmunity, presence of associated autoimmune disorders, response to treatment, and long-term prognosis are similar in both groups. The most common type of paediatric sclerosing cholangitis is ASC. The clinical, biochemical, immunological, and histological presentation of ASC is often indistinguishable from that of AIH type 1. In both, there are high IgG, non-organ specific autoantibodies, and interface hepatitis. Diagnosis is made by cholangiography. Children with ASC respond to immunosuppression satisfactorily and similarly to AIH in respect to remission and relapse rates, times to normalization of biochemical parameters, and decreased inflammatory activity on follow up liver biopsies. However, the cholangiopathy can progress. There may be evolution from AIH to ASC over the years, despite treatment. De novo AIH after liver transplantation affects patients not transplanted for autoimmune disorders and is strikingly reminiscent of classical AIH, including elevated titres of serum antibodies, hypergammaglobulinaemia, and histological findings of interface hepatitis, bridging fibrosis, and collapse. Like classical AIH, it responds to treatment with prednisolone and azathioprine. De novo AIH post liver transplantation may derive from interference by calcineurin inhibitors with the intrathymic physiological mechanisms of T-cell maturation and selection. Whether this condition is a

  19. Prolonged unexplained fatigue in paediatrics

    NARCIS (Netherlands)

    Bakker, R.J.

    2010-01-01

    Prolonged Unexplained Fatigue in Paediatrics. Fatigue, as the result of mental or physical exertion, will disappear after rest, drinks and food. Fatigue as a symptom of illness will recover with the recovering of the illness. But when fatigue is ongoing for a long time, and not the result of

  20. Paediatric diarrhoea rehydration therapy revisited

    African Journals Online (AJOL)

    Alive. 1539. 2035. Patients and methods. At the end of 1985, one of four paediatric inpatient wards ... handbooks, but thereafter a protocol was evolved in which emphasis was ... In the absence of an adequate short-stay facility, this ward had to ...

  1. Methodologies to assess paediatric adiposity.

    LENUS (Irish Health Repository)

    Horan, M

    2014-05-04

    Childhood obesity is associated with increased risk of adult obesity, cardiovascular disease, diabetes and cancer. Appropriate techniques for assessment of childhood adiposity are required to identify children at risk. The aim of this review was to examine core clinical measurements and more technical tools to assess paediatric adiposity.

  2. [News in paediatrics].

    Science.gov (United States)

    Depallens, Sarah; Lutz, Nicolas; Carlomagno, Raffaella; Meyrat, Blaise; Barazzoni, Mirjam Schuler; Tchameni, Yves Yamgoue; Pascual, Andres; Scerba, François; Superti-Furga, Andrea

    2016-01-13

    Every pediatrician will be confronted with newborns oryoung infants with skin lesions in proximity of the vertebral column. It is important not to miss a spinal dysraphism because of the risk of meningeal infection or of the possible presence of a tethered cord. A practical algorithm is presented. Non-accidental injury in young infants and toddlers is not rare but difficult to detect. Bruises and fractures are highly suspicious for non-accidental injury and should trigger specific investigations. Emergency departments and hospitals are switching from hypotonic to isotonic solutions as maintenance infusions of children. They reduce the risk of hyponatremia without increasing that of hypernatremia, and they should be used preferentially in the majority of pediatric clinical settings.

  3. Discrepancy in reporting among specialist registrars and the role of a paediatric neuroradiologist in reporting paediatric CT head examinations

    International Nuclear Information System (INIS)

    Nagaraja, S.; Ullah, Q.; Lee, K.J.; Bickle, I.; Hon, L.Q.; Griffiths, P.D.; Raghavan, A.; Flynn, P.; Connolly, D.J.A.

    2009-01-01

    considered to be significantly different than the GR in this study. The year of training did not have a statistically significant bearing on the discrepancy rates. This study has been useful in guiding SPR with regards to paediatric CT head examination reporting. The NR played an important role, particularly in picking up subtle fractures and congenital abnormalities, which were missed by both the SPR and GR.

  4. Paediatric Abdominal Surgical Emergencies in a General Surgical ...

    African Journals Online (AJOL)

    ... organized for general surgeons undertaking paediatric surgical emergencies. More paediatric surgeons should be trained and more paediatric surgical units should established in the country. Key Words: Paediatric Abdominal Surgical Emergencies; Paediatric Surgeons, General Surgeons. Journal of College of Medicine ...

  5. Dynamic intramedullary crosspinning technique for repair of distal femoral fractures in dogs and cats: 71 cases (1981-1985)

    International Nuclear Information System (INIS)

    Whitney, W.O.; Schrader, S.C.

    1987-01-01

    Dynamic intramedullary crosspinning was used in the surgical treatment of supracondylar and distal physeal fractures of the femur in 129 dogs and cats over a 5-year period; the records of the 44 dogs and 27 cats with follow-up information up to time of bony union were evaluated. The results were good or excellent in 66 of 71 animals (93%). The mean follow-up period was 22 months. Distal pin migration was the major complication (10 animals; 14%). The pin migrated before bony union in 2 animals because of instability and collapse at the fracture site. The pin migrated in 8 animals after bony union and was associated with intermittent lameness. In 5 of these, pin removal was performed and the lameness resolved

  6. Paediatric analgesia in an Emergency Department.

    LENUS (Irish Health Repository)

    Hawkes, C

    2012-02-03

    Timely management of pain in paediatric patients in the Emergency Department (ED) is a well-accepted performance indicator. We describe an audit of the provision of analgesia for children in an Irish ED and the introduction of a nurse-initiated analgesia protocol in an effort to improve performance. 95 children aged 1-16 presenting consecutively to the ED were included and time from triage to analgesia, and the rate of analgesia provision, were recorded. The results were circulated and a nurse initiated analgesia protocol was introduced. An audit including 145 patients followed this. 55.6% of patients with major fractures received analgesia after a median time of 54 minutes, which improved to 61.1% (p = 0.735) after 7 minutes (p = 0.004). Pain score documentation was very poor throughout, improving only slightly from 0% to 19.3%. No child had a documented pain score, which slightly improved to 19.3%. We recommend other Irish EDs to audit their provision of analgesia for children.

  7. [Kirschner wire osteosynthesis for fractures in childhood: bury wires or not? : Results of a survey on care reality in Germany].

    Science.gov (United States)

    Schneidmueller, D; Kertai, M; Bühren, V; von Rüden, C

    2018-02-20

    Kirschner wire osteosynthesis is considered to be the standard technique for surgical fixation of displaced supracondylar humeral and distal radial fractures in children. The Kirschner wires can be left exposed or buried under the skin. Advantages of the epicutaneous technique are, e. g. the efficiency (cost, effort) and the possibility for wire removal without the necessity of a second anesthesia. On the other hand, there is a concern about higher infection rates as well as traumatization of the children due to externally visible wires. A web-based survey of members of the DGU, DGOU, DGOOC, and the pediatric traumatology section of the DGU (SKT) was performed to evaluate current treatment concepts in Germany. The pros and cons for each technique were recorded and the need for a clinical study was examined. In addition, a cost analysis was performed for both methods. The results from the literature are summarized and discussed. A total of 710 questionnaires were evaluated. The majority of the respondents were trauma surgeons working in a hospital (80%). The buried technique was superior in both fracture groups (supracondylar humeral fractures 73% and distal radius fractures 69%), whereas a relevant difference could be found depending on the profession. The main reason for the subcutaneous technique was anxiety or observed higher infections using the epicutaneous technique. In Germany, the majority of wires are buried under the skin due to a fear of higher infection rates. In addition, other influencing factors such as pain and traditional approaches play a significant role. With respect to the results in the literature as well as a possible improvement of efficiency and avoidance of a second anesthesia, a multicentric clinical study seems necessary in the future to compare both techniques.

  8. Atlas of Bone Scintigraphy in the Developing Paediatric Skeleton: The Normal Skeleton, Variants and Pitfalls

    International Nuclear Information System (INIS)

    2011-01-01

    Since the introduction of 99m technetium polyphosphate in 1972 by Dr. M. Subramanian, bone scintigraphy has become an integral part of the evaluation of paediatric musculoskeletal disorders. Using the current high resolution gamma cameras and 99m technetium-methylene diphosphonate ( 99m Tc-MDP) or 99m Tc 2,3-dicarboxypropane-1,1-diphosphonate ( 99m Tc-DPD), the quality of images available for interpretation is high. From the very earliest days, there has been a certain confusion over normal bone physiology, as depicted by the bone scintigram in paediatric patients. This has resulted in a number of difficulties in detecting subtle abnormalities, especially near the dynamically changing scintigraphic presentation of the physes (growth zones). Examples of abnormalities that might be confused with normal bone activity are osteomyelitis, bucket handle fractures of the long bones, as well as neuroblastoma and leukaemic metastases. The aim of this publication is to provide structured information about the maturation and normal appearance of the skeleton from infancy to adulthood. As such, it reflects the current status of bone scintigraphy. It is hoped that this work will contribute to an enhanced understanding of the dynamic process of naturally occurring metabolic bone changes, which will, in turn, improve the quality of reporting of paediatric bone scans. As the majority of paediatric bone scintigrams are interpreted by non-paediatric nuclear physicians, the availability of this reference atlas should improve the care of children. This atlas is intended to address the needs of nuclear medicine physicians, both residents and specialists. It is intended to serve as an illustrative reference to those not having sufficient exposure to paediatric bone scan investigations, to enable them to maintain adequate competency in this particular application. Experts in paediatric nuclear medicine are often consulted for their opinion on bone scans obtained in their respective

  9. The Internet and the paediatric surgeon.

    Science.gov (United States)

    Srinivas, M; Inumpudi, A; Mitra, D K

    1998-12-01

    The Internet, which has truly united the world, is an extensive network of inter-linked computers storing immense bytes of information that can be accessed by anyone, transcending all barriers. The paediatric surgery Internet consists of exponentially growing material that deals with information specifically for paediatric surgeons and patients of the paediatric age group. We reviewed the methods available to take advantage of this network to enable busy paediatric surgeons to accrue the benefits easily and efficiently rather than be lost in the information ocean by surfing individually. By getting connected to the Internet, the paediatric surgeon gains enormous information that can be useful for patient care. The Internet has revolutionised scientific publications by virtue of its fast and accurate transmission of manuscripts. Paediatric surgeons can send manuscripts by this channel and also access journals, obviating the inherent lag period of communication by post.

  10. Hip Fracture

    Science.gov (United States)

    ... hip fractures in people of all ages. In older adults, a hip fracture is most often a result of a fall from a standing height. In people with very weak bones, a hip fracture can occur simply by standing on the leg and twisting. Risk factors The rate of hip fractures increases substantially with ...

  11. Consultant paediatric outreach clinics--a practical step in integration.

    Science.gov (United States)

    Spencer, N J

    1993-04-01

    Ten years' experience of paediatric outreach clinics is reviewed and evaluated. The advantages and disadvantages of paediatric outreach and its possible place in the new era of contracting and more developed community paediatric services are discussed. It is concluded that paediatric outreach increases parental and professional choice and access to paediatric consultant services, increases service flexibility, reduces unnecessary hospital visits, and enables more rational and relevant clinical decision making. Outreach is particularly relevant in areas of deprivation where paediatric needs are greatest.

  12. What's new in paediatric dentistry?

    Science.gov (United States)

    Vitale, M. C.

    2016-03-01

    Since the early 80's, the use of laser has been introduced in the daily dental practice and the technological development has also provided over time to optimize its use. Various types of lasers with different wavelengths have been developed for use in a handy, easy and ergonomic manner. In daily paediatric dentistry, laser could be a very useful medical device which can completely replace the traditional high hand-piece and bur to realize a "micro-invasive" dentistry and a "clean" surgery, without bleeding and sutures. According to the international literature and in the light of recent researches, this work could give an overview on assisted laser therapy in paediatric dentistry, highlighting advantages and disadvantages of this new technology and pointing out the high compliance of the young patient.

  13. Hypnosis in paediatric respiratory medicine.

    Science.gov (United States)

    McBride, Joshua J; Vlieger, Arine M; Anbar, Ran D

    2014-03-01

    Hypnotherapy is an often misunderstood yet effective therapy. It has been reported to be useful within the field of paediatric respiratory medicine as both a primary and an adjunctive therapy. This article gives a brief overview of how hypnotherapy is performed followed by a review of its applications in paediatric patients with asthma, cystic fibrosis, dyspnea, habit cough, vocal cord dysfunction, and those requiring non-invasive positive pressure ventilation. As the available literature is comprised mostly of case series, retrospective studies, and only a single small randomized study, the field would be strengthened by additional randomized, controlled trials in order to better establish the effectiveness of hypnosis as a treatment, and to identify the processes leading to hypnosis-induced physiologic changes. As examples of the utility of hypnosis and how it can be taught to children with respiratory disease, the article includes videos that demonstrate its use for patients with cystic fibrosis. Copyright © 2013 Elsevier Ltd. All rights reserved.

  14. Recent advances in paediatric gastroenterology.

    Science.gov (United States)

    Hansen, Richard; Russell, Richard K; Muhammed, Rafeeq

    2015-09-01

    Over the last few years, many changes have been introduced in the diagnosis and management of paediatric gastrointestinal problems. This review highlights the recent developments in Helicobacter pylori infection, eosinophilic oesophagitis, coeliac disease and inflammatory bowel disease. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  15. A focus on paediatric hypertension

    Directory of Open Access Journals (Sweden)

    Pier Paolo Bassareo

    2015-04-01

    Full Text Available Hypertension can begin early in childhood, as occasional increases in blood pressure or abnormal blood pressure responses to physical or emotional stress. High blood pressure in juvenile age is defined as a blood pressure repeatedly above the 95th percentile of specific nomograms. Its worldwide prevalence ranges from 1% to about 10%. The purpose of this paper is to perform an overview about characteristics, diagnosis, risk factors, therapy, and prognosis of paediatric hypertension.

  16. Paediatric sunburn: the experience of an Australian paediatric burns unit.

    Science.gov (United States)

    Mah, Latifa; Di Giovine, Paul; Quinn, Linda; Sparnon, Anthony

    2013-08-01

    The number of hospital presentations and admissions for treatment of sunburn remains significant, despite efforts to educate the public regarding sun protection. Current literature chiefly examines public health campaigns and sun protection behaviours and attitudes. There are very few articles that explore paediatric sunburn requiring hospital presentation. This study was therefore undertaken to provide a snapshot of this issue and to identify patterns and causative factors in the development of severe sunburn requiring hospital presentation. Data were collected for retrospective analysis from case records of patients who presented with sunburn and were registered on the Burns Service database at the Women's and Children's Hospital in South Australia. This study includes patients who presented during the period of October 2006 to March 2011. There were 81 cases identified over the period of 2006-2011 from the Burns database that had sufficient information for the purpose of this study. Factors such as outdoor activity and water sports were predictably apparent, with patients being burned on days with extremely high ultraviolet ratings. Key patterns that emerged were location of sunburn and sun protection use, which were gender and age specific. Larger-scale studies are warranted to further delineate the contributing factors and to identify the specific populations of children at risk of sunburn. Future educational programmes can therefore target these subgroups and behaviours for effective prevention of sunburn. Tailored campaigns that address these factors may be of greater impact in reducing hospital presentations and admissions of significant sunburn. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  17. Pediatric fractures – an educational needs assessment of Canadian pediatric emergency medicine residents

    Directory of Open Access Journals (Sweden)

    Dixon AC

    2015-06-01

    Full Text Available Andrew C Dixon Department of Pediatrics, University of Alberta, Edmonton, AB, Canada Objectives: To determine the gaps in knowledge of Canadian pediatric emergency medicine residents with regards to acute fracture identification and management. Due to their predominantly medical prior training, fractures may be an area of weakness requiring a specific curriculum to meet their needs. Methods: A questionnaire was developed examining comfort level and performance on knowledge based questions of trainees in the following areas: interpreting musculoskeletal X-rays; independently managing pediatric fractures, physical examination techniques, applied knowledge of fracture management, and normal development of the bony anatomy. Using modified Dillman technique the instrument was distributed to pediatric emergency medicine residents at seven Canadian sites. Results: Out of 43 potential respondents, 22 (51% responded. Of respondents, mean comfort with X-ray interpretation was 69 (62–76 95% confidence interval [CI] while mean comfort with fracture management was only 53 (45–63 95% CI; mean comfort with physical exam of shoulder 60 (53–68 95% CI and knee 69 (62–76 95% CI was low. Less than half of respondents (47%; 95% CI 26%–69% could accurately identify normal wrist development, correctly manage a supracondylar fracture (39%; 95% CI 20%–61%, or identify a medial epicondyle fracture (44%; 95% CI 24%–66%. Comfort with neurovascular status of the upper (mean 82; 95% CI 75–89 and lower limb (mean 81; 95% CI 74–87 was high. Interpretation: There are significant gaps in knowledge of physical exam techniques, fracture identification and management among pediatric emergency medicine trainees. A change in our current teaching methods is required to meet this need. Keywords: pediatric, fractures, education, radiologic interpretation

  18. Predisposing Effect of Elbow Alignment on the Elbow Fracture Type in Children.

    Science.gov (United States)

    Kang, Seungcheol; Park, Soo-Sung

    2015-08-01

    Under the hypothesis that the elbow alignment, namely the carrying angle, could predispose individuals to a specific type of pediatric elbow fracture after a fall onto an outstretched arm, we investigated the relationship between radiographic carrying angle and elbow fracture type in children. Retrospective case-control study. Level I pediatric trauma center. We reviewed 374 children who were diagnosed with supracondylar fracture (SCF, n = 208), lateral condylar fracture (LCF, n = 132), and radial neck fracture (RNF, n = 34). The association between the radiographic carrying angle and the fracture type was investigated. To adjust for bias, 2 statistical methods were used: multivariate analysis using a baseline-category logistic model and a case-matching method using propensity score analysis. In the multivariate analysis, with SCF patients set as the baseline category, a more valgus-deviated elbow (increased carrying angle, P = 0.011) predisposed individuals to RNF, whereas a more varus-deviated elbow (decreased carrying angle, P predisposed them to LCF. In the case-matched analysis, there were also significant differences in carrying angles between RNF and case-matched SCF patients (14.3 vs. 11.4 degrees, P = 0.013) and between LCF and case-matched SCF patients (7.7 vs. 11.7 degrees, P fall onto an outstretched elbow, could be a predisposing factor for specific types of pediatric elbow fracture. The results provide the additional information about the injury mechanisms of pediatric elbow fracture and may deepen our understanding of the fractures. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

  19. Anaesthetic considerations for paediatric laparoscopy | Lasersohn ...

    African Journals Online (AJOL)

    Children, infants and neonates represent an anaesthetic challenge because of age-specific anatomical and physiological issues. Apart from paediatric-specific anaesthetic considerations, the paediatric anaesthetist must understand the implications of laparoscopic surgery, and prevent and react appropriately to changes ...

  20. Onset symptoms in paediatric multiple sclerosis

    DEFF Research Database (Denmark)

    Boesen, Magnus Spangsberg; Sellebjerg, Finn; Blinkenberg, Morten

    2014-01-01

    INTRODUCTION: Paediatric multiple sclerosis (MS) carries a relatively higher mortality and morbidity than adult MS. Paediatric MS symptoms and paraclinical findings at the first demyelinating event have never before been characterised in a Danish setting. The aim of this study was to compare...

  1. Anaesthesia for Ambulatory Paediatric Surgery: Common ...

    African Journals Online (AJOL)

    BACKGROUND: Ambulatory surgical care accounts for over 70% of elective procedures in Northern America. Ambulatory paediatric surgical practice is not widespread in Nigeria. This report examined clinical indicators for quality care in paediatric ambulatory surgery using common outcomes after day case procedures as ...

  2. Appendicitis in paediatric age group: Correlation between ...

    African Journals Online (AJOL)

    Introduction: Clinical diagnosis of appendicitis can be challenging, particularly in the paediatric age group. There is an increased risk of perforation in paediatrics; therefore, a need for sensitive and specific diagnostic tool is mandatory. Aim: The aim of this study is to evaluate the role of preoperative inflammatory markers in ...

  3. Congenital malformations in paediatric and neurosurgical practices ...

    African Journals Online (AJOL)

    Congenital malformations in paediatric and neurosurgical practices: problems and pattern (A preliminary report) ... Open Access DOWNLOAD FULL TEXT ... over a 5-year period (1998 to 2002) with congenital anomalies to the Paediatric Surgery and Neurosurgery units of the University Teaching Hospital, Ilorin, Nigeria.

  4. Comparison of Primary Hip Spica with Crossed Retrograde Intramedullary Rush Pins for the Management of Diaphyseal Femur Fractures in Children: A Prospective, Randomized Study

    Directory of Open Access Journals (Sweden)

    Mohammad Ruhullah

    2013-12-01

    Conclusions: Intra-medullary crossed Rush pinning is an effective method of paediatric diaphyseal femur fracture fixation as compared to primary hip spica in terms of early weight bearing and restoration of normal anatomy.

  5. Transfusion therapy in paediatric trauma patients

    DEFF Research Database (Denmark)

    Nystrup, Kristin Brønnum; Stensballe, Jakob; Bøttger, Morten

    2015-01-01

    Haemorrhage is a leading cause of death in paediatric trauma patients. Predefined massive transfusion protocols (MTP) have the potential to significantly reduce mortality by treating haemorrhagic shock and coagulopathy, in adhering to the principles of haemostatic resuscitation with rapid...... in paediatric trauma patients is challenging, and the optimal blood product ratio that will increase survival in massively bleeding paediatric trauma patients has yet to be determined. To date, only a few small descriptive studies and case reports have investigated the use of predefined MTP in paediatric trauma...... patients.MTP with increased FFP or PLT to RBC ratios combined with viscoelastic haemostatic assay (VHA) guided haemostatic resuscitation have not yet been tested in paediatric populations but based on results from adult trauma patients, this therapeutic approach seems promising.Considering the high...

  6. Rib Fractures

    Science.gov (United States)

    ... Video) Achilles Tendon Tear Additional Content Medical News Rib Fractures By Thomas G. Weiser, MD, MPH, Associate Professor, ... Tamponade Hemothorax Injury to the Aorta Pulmonary Contusion Rib Fractures Tension Pneumothorax Traumatic Pneumothorax (See also Introduction to ...

  7. Root fractures

    DEFF Research Database (Denmark)

    Andreasen, Jens Ove; Christensen, Søren Steno Ahrensburg; Tsilingaridis, Georgios

    2012-01-01

    The purpose of this study was to analyze tooth loss after root fractures and to assess the influence of the type of healing and the location of the root fracture. Furthermore, the actual cause of tooth loss was analyzed....

  8. Conventional imaging in paediatric uroradiology

    International Nuclear Information System (INIS)

    Riccabona, M.; Lindbichler, F.; Sinzig, M.

    2002-01-01

    Objective: To briefly describe basic conventional imaging in paediatric uroradiology. Method: The state of the art performance of standard imaging techniques (intravenous urography (IVU), voiding cystourethrography (VCU), and ultrasound (US)) is described, with emphasis on technical aspects, indications, and patient preparation such as adequate hydration. Only basic applications as used in routine clinical work are included. Result and conclusion: Conventional imaging methods are irreplaceable. They cover the majority of daily clinical routine queries, with consecutive indication of more sophisticated modalities in those patients who need additional imaging for establishing the final diagnosis or outlining therapeutic options

  9. Conventional imaging in paediatric uroradiology

    Energy Technology Data Exchange (ETDEWEB)

    Riccabona, M. E-mail: michael.riccabona@kfunigraz.ac.at; Lindbichler, F.; Sinzig, M

    2002-08-01

    Objective: To briefly describe basic conventional imaging in paediatric uroradiology. Method: The state of the art performance of standard imaging techniques (intravenous urography (IVU), voiding cystourethrography (VCU), and ultrasound (US)) is described, with emphasis on technical aspects, indications, and patient preparation such as adequate hydration. Only basic applications as used in routine clinical work are included. Result and conclusion: Conventional imaging methods are irreplaceable. They cover the majority of daily clinical routine queries, with consecutive indication of more sophisticated modalities in those patients who need additional imaging for establishing the final diagnosis or outlining therapeutic options.

  10. PREVENTIVE PAEDIATRICS — NEW CHALLENGES

    Directory of Open Access Journals (Sweden)

    A. A. Baranov

    2012-01-01

    Full Text Available The article takes up priority directions of preventive paediatrics concerning health formation of rising generation, organization of health care for children, decrease of morbidity, disability and mortality rate. The authors mention the importance of vaccination in control of the most common infections, base the necessity of complex rehabilitation health care system organization for disable children and need of wide spreading of developed and used in practical Russian health care types and methods of prophylaxis of rare (orphan diseases. The ways of prophylaxis, maintenance, strengthening and recovery of children’s health are suggested in this article.

  11. Canadian Paediatric Neurology Workforce Survey and Consensus Statement.

    Science.gov (United States)

    Doja, Asif; Orr, Serena L; McMillan, Hugh J; Kirton, Adam; Brna, Paula; Esser, Michael; Tang-Wai, Richard; Major, Philippe; Poulin, Chantal; Prasad, Narayan; Selby, Kathryn; Weiss, Shelly K; Yeh, E Ann; Callen, David Ja

    2016-05-01

    Little knowledge exists on the availability of academic and community paediatric neurology positions. This knowledge is crucial for making workforce decisions. Our study aimed to: 1) obtain information regarding the availability of positions for paediatric neurologists in academic centres; 2) survey paediatric neurology trainees regarding their perceptions of employment issues and career plans; 3) survey practicing community paediatric neurologists 4) convene a group of paediatric neurologists to develop consensus regarding how to address these workforce issues. Surveys addressing workforce issues regarding paediatric neurology in Canada were sent to: 1) all paediatric neurology program directors in Canada (n=9) who then solicited information from division heads and from paediatric neurologists in surrounding areas; 2) paediatric neurology trainees in Canada (n=57) and; 3) community paediatric neurologists (n=27). A meeting was held with relevant stakeholders to develop a consensus on how to approach employment issues. The response rate was 100% from program directors, 57.9% from residents and 44% from community paediatric neurologists. We found that the number of projected positions in academic paediatric neurology is fewer than the number of paediatric neurologists that are being trained over the next five to ten years, despite a clinical need for paediatric neurologists. Paediatric neurology residents are concerned about job availability and desire more career counselling. There is a current and projected clinical demand for paediatric neurologists despite a lack of academic positions. Training programs should focus on community neurology as a viable career option.

  12. Interpretation of Chemical Pathology Test Results in Paediatrics ...

    African Journals Online (AJOL)

    At any time we interprete paediatric chemical pathology test results we must take into consideration a number of factors, which are related with and restricted to paediatric patients. Such factors include the paediatric patient's age that may change from prematurity to above 18 years, and the paediatric patient's body weight ...

  13. Stress Fractures

    Science.gov (United States)

    Stress fractures Overview Stress fractures are tiny cracks in a bone. They're caused by repetitive force, often from overuse — such as repeatedly jumping up and down or running long distances. Stress fractures can also arise from normal use of ...

  14. Provision of general paediatric surgical services in a regional hospital.

    LENUS (Irish Health Repository)

    Zgraj, O

    2012-01-31

    BACKGROUND: In Ireland, specialist paediatric surgery is carried out in paediatric hospitals in Dublin. General surgeons\\/consultants in other surgical specialities provide paediatric surgical care in regional centres. There has been a failure to train general surgeons with paediatric skills to replace these surgeons upon retirement. AIM: To assess paediatric surgical workload in one regional centre to focus the debate regarding the future provision of general paediatric surgery in Ireland. METHODS: Hospital in-patient enquiry (HIPE) system was used to identify total number of paediatric surgical admissions and procedures. Cases assessed requiring hospital transfer. RESULTS: Of 17,478 surgical patients treated, 2,584 (14.8%) were under 14 years. A total of 2,154 procedures were performed. CONCLUSION: Regional centres without dedicated paediatric surgeons deliver care to large numbers of paediatric patients. The demand for care highlights the need for formal paediatric services\\/appropriate surgical training for general surgical trainees.

  15. Parental knowledge of paediatric vaccination

    Directory of Open Access Journals (Sweden)

    Borràs Eva

    2009-05-01

    Full Text Available Abstract Background Although routine vaccination is a major tool in the primary prevention of some infectious diseases, there is some reluctance in a proportion of the population. Negative parental perceptions of vaccination are an important barrier to paediatric vaccination. The aim of this study was to investigate parental knowledge of paediatric vaccines and vaccination in Catalonia. Methods A retrospective, cross-sectional study was carried out in children aged Results An association was observed between greater vaccination coverage of the 4:4:4:3:1 schedule (defined as: 4 DTPa/w doses, 4 Hib doses, 4 OPV doses, 3 MenC doses and 1 MMR dose and maternal age >30 years (OR: 2.30; 95% CI: 1.20–4.43 and with a knowledge of vaccination score greater than the mean (OR: 0.45; 95% CI: 0.28–0.72. The score increased with maternal educational level and in parents of vaccinated children. A total of 20.47% of parents stated that vaccines could have undesirable consequences for their children. Of these, 23.26% had no specific information and 17.83% stated that vaccines can cause adverse reactions and the same percentage stated that vaccines cause allergies and asthma. Conclusion Higher vaccination coverage is associated with older maternal age and greater knowledge of vaccination. Vaccination coverage could be raised by improving information on vaccines and vaccination.

  16. Acetabular Fracture

    Directory of Open Access Journals (Sweden)

    Chad Correa

    2017-09-01

    Full Text Available History of present illness: A 77-year-old female presented to her primary care physician (PCP with right hip pain after a mechanical fall. She did not lose consciousness or have any other traumatic injuries. She was unable to ambulate post-fall, so X-rays were ordered by her PCP. Her X-rays were concerning for a right acetabular fracture (see purple arrows, so the patient was referred to the emergency department where a computed tomography (CT scan was ordered. Significant findings: The non-contrast CT images show a minimally displaced comminuted fracture of the right acetabulum involving the acetabular roof, medial and anterior walls (red arrows, with associated obturator muscle hematoma (blue oval. Discussion: Acetabular fractures are quite rare. There are 37 pelvic fractures per 100,000 people in the United States annually, and only 10% of these involve the acetabulum. They occur more frequently in the elderly totaling an estimated 4,000 per year. High-energy trauma is the primary cause of acetabular fractures in younger individuals and these fractures are commonly associated with other fractures and pelvic ring disruptions. Fractures secondary to moderate or minimal trauma are increasingly of concern in patients of advanced age.1 Classification of acetabular fractures can be challenging. However, the approach can be simplified by remembering the three basic types of acetabular fractures (column, transverse, and wall and their corresponding radiologic views. First, column fractures should be evaluated with coronally oriented CT images. This type of fracture demonstrates a coronal fracture line running caudad to craniad, essentially breaking the acetabulum into two halves: a front half and a back half. Secondly, transverse fractures should be evaluated by sagittally oriented CT images. By definition, a transverse fracture separates the acetabulum into superior and inferior halves with the fracture line extending from anterior to posterior

  17. A Removable Long-arm Soft Cast to Treat Nondisplaced Pediatric Elbow Fractures: A Randomized, Controlled Trial.

    Science.gov (United States)

    Silva, Mauricio; Sadlik, Gal; Avoian, Tigran; Ebramzadeh, Edward

    2018-04-01

    The ideal type of immobilization for nondisplaced pediatric elbow fractures has not been established. We hypothesized that the use of a long-arm cylinder made of soft cast material will result in similar outcomes to those obtained with a traditional long-arm hard cast. We randomly assigned 100 consecutive children who presented with a closed, nondisplaced, type I supracondylar humeral fracture or an occult, closed, acute elbow injury, to 1 of 2 groups: group A (n=50) received a long-arm, traditional fiberglass (hard) cast. Group B (n=50) received a long-arm, soft fiberglass cast. After 4 weeks, the cast was removed in group A by a member of our staff using a cast saw, and in group B by one of the patient's parents by rolling back the soft fiberglass material. We compared the amount of fracture displacement and/or angulation, recovery of range of motion, elbow pain, and patient satisfaction. There were no instances of unplanned removal of the cast by the patient or parent. No evidence of fracture displacement or angulation was seen in either group. The final carrying angle of the affected elbow was nearly identical of that of the normal, contralateral elbow in both groups (P=0.64). At the latest follow-up appointment, elbows in groups A and B had a similar mean arc of motion (156 vs. 154 degrees; P=0.45), and had achieved identical relative arc of motion of 99.6% and 99.5% of that of the normal, contralateral side, respectively (P=0.94). Main pain scores were low and comparable over the study period. All patients in both groups reported the highest rate of satisfaction at the eighth week of follow-up. The results indicate that children with nondisplaced supracondylar humeral fractures can be successfully managed with the use of a removable long-arm soft cast, maintaining fracture alignment and resulting in comparable rates of range of motion, pain, and patient satisfaction. The use of a removable immobilization that can reliably maintain fracture alignment and

  18. Radiation Protection in Paediatric Radiology

    International Nuclear Information System (INIS)

    2012-01-01

    Over the past decade and a half, special issues have arisen regarding the protection of children undergoing radiological examinations. These issues have come to the consciousness of a gradually widening group of concerned professionals and the public, largely because of the natural instinct to protect children from unnecessary harm. Some tissues in children are more sensitive to radiation and children have a long life expectancy, during which significant pathology can emerge. The instinct to protect children has received further impetus from the level of professional and public concern articulated in the wake of media responses to certain publications in the professional literature. Many institutions have highlighted the need to pay particular attention to the special problems of protecting paediatric patients. The International Commission on Radiological Protection has noted it and the IAEA's General Safety Requirements publication, Radiation Protection and Safety of Radiation Sources: International Basic Safety Standards (BSS), requires it. This need has been endorsed implicitly in the advisory material on paediatric computed tomography scanning issued by bodies such as the US Food and Drug Administration and the National Cancer Institute in the United States of America, as well as by many initiatives taken by other national and regional radiological societies and professional bodies. A major part of patient exposure, in general, and paediatric exposure, in particular, now arises from practices that barely existed two decades ago. For practitioners and regulators, it is evident that this innovation has been driven both by the imaging industry and by an ever increasing array of new applications generated and validated in the clinical environment. Regulation, industrial standardization, safety procedures and advice on best practice lag (inevitably) behind industrial and clinical innovations. This Safety Report is designed to consolidate and provide timely advice on

  19. [Challenges in acute paediatric medicine].

    Science.gov (United States)

    Moll, Henriette A

    2016-01-01

    A big drop in the number of severe infections has resulted in less experience in recognising a seriously ill child. The challenge is finding a safe and effective balance between high-quality expertise and quickly accessible care, while avoiding over-diagnosis. There are a number of tools available to aid recognition of a seriously ill child and to avoid delay in diagnostic procedures and treatment: the use of a validated paediatric triage system, validated decision rules and guidelines, listening carefully to the parents ('my child's illness is different this time'), the clinical intuition of the experienced paediatrician and the provision of good 'safety net' advice to parents concerning the alarm signals and when they should contact a care provider. Experienced paediatricians should be at the forefront in the evaluation of the acutely ill child in order to teach their younger colleagues the importance of various alarm signals and the role played by clinical intuition.

  20. Radiation Effects in Paediatric radiography

    International Nuclear Information System (INIS)

    Mutwasi, O.

    2006-01-01

    Diagnostic imaging has evolved from single technique to a field which we have a choice from many modalities. Some without radiation. Radiation producing modalities include plain films (low dose), Fluoroscopy (mid range dose), Computed tomography (high dose). Radiography dose can significantly be influenced in plain radiography by varying speed of screens, cassette construction and type of radiography. E.g. digital or computed. In computed or digital radiography we are no longer able to tell h igh dose b y the quality of images. The final image is by great extend a product of post processing algorithms. It's for this reasons that the basic understanding of the sensitivity and specifying of various types of examinations and of specifically radiation effects is mandatory for a paediatric imager

  1. A clinical update on paediatric lupus

    African Journals Online (AJOL)

    Personal reference lists of the 3 authors were used in this update. ... with a paediatric specialist so that a tailored management plan can be made, depending ..... Cassidy JT, Petty RE, Laxer RM, Lindsley L.Textbook of Pediatric Rheumatology.

  2. The global burden of paediatric heart disease

    DEFF Research Database (Denmark)

    Musa, Ndidiamaka L; Hjortdal, Vibeke; Zheleva, Bistra

    2017-01-01

    An estimated 15 million children die or are crippled annually by treatable or preventable heart disease in low- and middle-income countries. Global efforts to reduce under-5 mortality have focused on reducing death from communicable diseases in low- and middle-income countries with little...... to no attention focusing on paediatric CHD and acquired heart disease. Lack of awareness of CHD and acquired heart disease, access to care, poor healthcare infrastructure, competing health priorities, and a critical shortage of specialists are important reasons why paediatric heart disease has not been addressed...... in low resourced settings. Non-governmental organisations have taken the lead to address these challenges. This review describes the global burden of paediatric heart disease and strategies to improve the quality of care for paediatric heart disease. These strategies would improve outcomes for children...

  3. Recent developments in neonatal and paediatric emergencies.

    Science.gov (United States)

    Turner, Nigel M

    2011-07-01

    The present article is intended as an update for anaesthesiologists on recent developments in life-threatening paediatric emergencies and paediatric resuscitation. It is assumed that the reader has at least a basic knowledge of the general principles of emergency medicine, such as the ABCDE-approach and the principle of 'treat first what kills first'; and also that the reader is familiar with the anatomical, physiological and psychological differences between adults and children. The article begins with a description of the background to paediatric emergencies followed by a description of a widely used systematic approach to the assessment of the seriously ill child. In the second half of the article, the principles of the initial treatment for acute, life-threatening problems in children and paediatric resuscitation are discussed with reference to the recent literature. The article ends with a discussion of the changes in latest guidelines for resuscitation of babies at birth.

  4. ORIGINAL ARTICLES HIV transmission during paediatric health ...

    African Journals Online (AJOL)

    prevalence in paediatric health care settings in Africa, risks for horizontal ... 29 West Governer Road, Hershey, Pennsylvania, USA. David Gisselquist, PhD ..... tolerance policy for HIV transmission through health care. February 2004, Vol.

  5. FORUM Paediatric living donor liver transplantation

    African Journals Online (AJOL)

    879 November 2012, Vol. 102, No. 11 SAMJ. REVIEW. Paediatric living donor liver transplantation ... been excellent after left lateral segmentectomy, with a usually quoted ... has led to the development of new surgical techniques to increase.

  6. Vedolizumab in Paediatric Inflammatory Bowel Disease

    DEFF Research Database (Denmark)

    Ledder, Oren; Assa, Amit; Levine, Arie

    2017-01-01

    Background: Vedolizumab, an anti-integrin antibody, has proven to be effective in adults with inflammatory bowel disease [IBD], but the data in paediatrics are limited. We describe the short-term effectiveness and safety of vedolizumab in a European multi-centre paediatric IBD cohort. Method......: Retrospective review of children [aged 2-18 years] treated with vedolizumab from 19 centres affiliated with the Paediatric IBD Porto group of ESPGHAN. Primary outcome was Week 14 corticosteroid-free remission [CFR]. Results: In all, 64 children were included (32 [50%] male, mean age 14.5 ± 2.8 years...... minor drug-related adverse events. Only 3 of 16 children who underwent endoscopic evaluation had mucosal healing after treatment (19%). Conclusions: Vedolizumab was safe and effective in this cohort of paediatric refractory IBD. These data support previous findings of slow induction rate of vedolizumab...

  7. Job satisfaction and burnout among paediatric nurses.

    Science.gov (United States)

    Akman, Ozlem; Ozturk, Candan; Bektas, Murat; Ayar, Dijle; Armstrong, Merry A

    2016-10-01

    This study aims to determine factors of job satisfaction and burnout levels of paediatric nurses. A total of 165 nurses working in paediatric clinics completed the Minnesota job satisfaction scale and the Maslach burnout scale. Average scores of the emotional exhaustion and depersonalisation score were low, while personal accomplishment scores were high. A high level of job satisfaction, being married, increased age and a decreased number of assigned patients were significantly associated with a low level of burnout. Paediatric nurses experience burnout at significant levels. The most important variable that affected job satisfaction was income. The results of the study could guide development of strategies that might prevent or alleviate burnout of paediatric nurses. © 2016 John Wiley & Sons Ltd.

  8. [Treatment of pediatric distal femur fractures by external fixator combined with limited internal fixation].

    Science.gov (United States)

    Wei, Sheng-wang; Shi, Zhan-ying; Hu, Ju-zheng; Wu, Hao

    2016-03-01

    To discuss the clinical effects of external fixator combined with limited internal fixation in the treatment of pediatric distal femur fractures. From January 2008 to June 2014, 17 children of distal femur fractures were treated by external fixator combined with limited internal fixation. There were 12 males and 5 females, aged from 6 to 13 years old with an average of 10.2 years, ranged in the course of disease from 1 h to 2 d. Preoperative diagnoses were confirmed by X-ray films in all children. There were 11 patients with supracondylar fracture , and 6 patients with intercondylar comminuted fracture. According to AO/ASIF classification, 9 fractures were type A1, 5 cases were type A2,and 3 cases were type C1. The intraoperative and postoperative complications, postoperative radiological examination, lower limbs length and motion of knee joints were observed. Knee joint function was assessed by KSS score. All the patients were followed up from 6 to 38 months with an average of 24.4 months. No nerve or blood vessel injury was found. One case complicated with the external fixation loosening, 2 cases with the infection of pin hole and 3 cases with the leg length discrepancy. Knee joint mobility and length measurement (compared with the contralateral), the average limited inflexion was 10 degrees (0 degrees to 20 degrees), the average limited straight was 4 degrees (0 degrees to 10), the average varus or valgus angle was 3 degrees (0 degrees to 5 degrees). KSS of the injured side was (96.4 +/- 5.0) points at final follow-up, 16 cases got excellent results and 1 good. All fractures obtained healing and no epiphyseal closed early was found. External fixator combined with limited internal fixation has advantages of simple operation, reliable fixation, early functional exercise in treating pediatric distal femurs fractures.

  9. Mandible Fractures.

    Science.gov (United States)

    Pickrell, Brent B; Serebrakian, Arman T; Maricevich, Renata S

    2017-05-01

    Mandible fractures account for a significant portion of maxillofacial injuries and the evaluation, diagnosis, and management of these fractures remain challenging despite improved imaging technology and fixation techniques. Understanding appropriate surgical management can prevent complications such as malocclusion, pain, and revision procedures. Depending on the type and location of the fractures, various open and closed surgical reduction techniques can be utilized. In this article, the authors review the diagnostic evaluation, treatment options, and common complications of mandible fractures. Special considerations are described for pediatric and atrophic mandibles.

  10. Facial Fractures.

    Science.gov (United States)

    Ghosh, Rajarshi; Gopalkrishnan, Kulandaswamy

    2018-06-01

    The aim of this study is to retrospectively analyze the incidence of facial fractures along with age, gender predilection, etiology, commonest site, associated dental injuries, and any complications of patients operated in Craniofacial Unit of SDM College of Dental Sciences and Hospital. This retrospective study was conducted at the Department of OMFS, SDM College of Dental Sciences, Dharwad from January 2003 to December 2013. Data were recorded for the cause of injury, age and gender distribution, frequency and type of injury, localization and frequency of soft tissue injuries, dentoalveolar trauma, facial bone fractures, complications, concomitant injuries, and different treatment protocols.All the data were analyzed using statistical analysis that is chi-squared test. A total of 1146 patients reported at our unit with facial fractures during these 10 years. Males accounted for a higher frequency of facial fractures (88.8%). Mandible was the commonest bone to be fractured among all the facial bones (71.2%). Maxillary central incisors were the most common teeth to be injured (33.8%) and avulsion was the most common type of injury (44.6%). Commonest postoperative complication was plate infection (11%) leading to plate removal. Other injuries associated with facial fractures were rib fractures, head injuries, upper and lower limb fractures, etc., among these rib fractures were seen most frequently (21.6%). This study was performed to compare the different etiologic factors leading to diverse facial fracture patterns. By statistical analysis of this record the authors come to know about the relationship of facial fractures with gender, age, associated comorbidities, etc.

  11. ALARA and paediatric imaging in radiation therapy: A survey of Canadian paediatric imaging practice

    International Nuclear Information System (INIS)

    Rodgerson, Christine

    2014-01-01

    Purpose: There is little discussion in the literature regarding paediatric imaging dose reduction with respect to conventional imaging carried out in radiotherapy departments. This is in contrast to diagnostic radiography where dose optimization when imaging children is a very current topic. For this reason Canadian radiotherapy clinics were surveyed to look at paediatric imaging practice, knowledge and perspectives with respect to imaging dose reduction. Method: As this was an exploratory study, a questionnaire was developed and sent to radiation therapy clinics across Canada, via email, to assess knowledge of paediatric imaging and dose reduction initiatives. The questionnaire focus was CT simulation and treatment verification imaging of children. Results: Practice and knowledge of paediatric imaging varied across Canada. Forty percent of clinics reported using paediatric specific protocols for CT simulation and 20% of clinics reported using paediatric specific protocols for treatment verification imaging. There was variation in imaging practices among the clinics that reported treating the most children. The survey results show that while some measures are being taken to reduce paediatric imaging dose in radiation therapy, 46.7% of the respondents felt more could be done. Conclusion: The survey demonstrates interest in dose reduction in radiation therapy imaging as well as differences in current practice and knowledge across Canada. Paediatric imaging dose reduction would appear to be an area of practice that would benefit from more study and development of standards of practice

  12. Conservative treatment of Malgaigne fracture in young female - case report

    Directory of Open Access Journals (Sweden)

    Vukašinović Zoran

    2013-01-01

    Full Text Available Introduction. Pelvic ring injuries usually result from high­energy trauma, and cranial and abdominal multiple injuries are frequently present. Malgaigne fracture is referred to pelvic ring disruption at two sites, and is often treated surgically for its instability. We present a case of nonoperative treatment of Malgaigne pelvic fracture. Case Outline. A 17­year­old girl sustained a Malgaigne fracture falling off a horse. After ruling out urgent multiple trauma in local hospital, she was then transferred to Pediatric Orthopedic and Trauma Service at the Institute of Orthopedic Surgery «Banjica» Belgrade, with provisional cutaneous traction of 2 kg applied to her right leg. After the status evaluation, the supracondylar femoral traction was applied for three months, combined with pelvic cradle for first 73 days. Weight of traction was gradually adjusted according to x­ray check­up, ranging from 1­16 kg (1/4 of body weight. Antibiotic prophylaxis was administered for 10 days, and thromboprophylaxis for two months. After the removal of traction, physical therapy was applied and the patient achieved full weight bearing four months after the injury. Treatment outcome was a symmetric and stable pelvic ring, equal leg length, full range of motion in both hip joints and normal walking. Conclusion. Traction therapy, combined with gravitational suspension in pelvic cradle, resulted in excellent clinical result. Although significantly longer and more loaded than usual, normal weight bearing and walking were promptly achieved using intensive physical therapy. [Projekat Ministarstva nauke Republike Srbije, br. III 41004

  13. Fracture sacrum.

    Directory of Open Access Journals (Sweden)

    Dogra A

    1995-04-01

    Full Text Available An extremely rare case of combined transverse and vertical fracture of sacrum with neurological deficit is reported here with a six month follow-up. The patient also had an L1 compression fracture. The patient has recovered significantly with conservative management.

  14. Fracture Mechanics

    CERN Document Server

    Zehnder, Alan T

    2012-01-01

    Fracture mechanics is a vast and growing field. This book develops the basic elements needed for both fracture research and engineering practice. The emphasis is on continuum mechanics models for energy flows and crack-tip stress- and deformation fields in elastic and elastic-plastic materials. In addition to a brief discussion of computational fracture methods, the text includes practical sections on fracture criteria, fracture toughness testing, and methods for measuring stress intensity factors and energy release rates. Class-tested at Cornell, this book is designed for students, researchers and practitioners interested in understanding and contributing to a diverse and vital field of knowledge. Alan Zehnder joined the faculty at Cornell University in 1988. Since then he has served in a number of leadership roles including Chair of the Department of Theoretical and Applied Mechanics, and Director of the Sibley School of Mechanical and Aerospace Engineering.  He teaches applied mechanics and his research t...

  15. [Promotion of breast feeding in paediatric outpatient settings].

    Science.gov (United States)

    Böse-O'Reilly, S; Wermuth, I; Hellmann, J; Siebert, U; Lob-Corzilius, T

    2008-03-01

    With some data and examples it can be shown that the competence and the knowledge of paediatric doctor's assistants and paediatric nurses can and should be improved. The training courses to become a "prevention assistant" have been very positively accepted by doctor's assistants and paediatric nurses, and it seems an appropriate method to reach these aims. Prevention and especially promotion of breast feeding is possible in paediatric outpatient settings. The immediate contact between infants, parents, paediatric doctor's assistants, paediatric nurses, and doctors offers a unique opportunity to promote the health of children, mainly due to the high acceptance of regular check-ups. So why not introduce the promotion of breast feeding in paediatric outpatient settings with specially trained doctor's assistants and paediatric nurses?

  16. Algorithm for optimisation of paediatric chest radiography

    International Nuclear Information System (INIS)

    Kostova-Lefterova, D.

    2016-01-01

    The purpose of this work is to assess the current practice and patient doses in paediatric chest radiography in a large university hospital. The X-ray unit is used in the paediatric department for respiratory diseases. Another purpose was to recommend and apply optimized protocols to reduce patient dose while maintaining diagnostic image quality for the x-ray images. The practice of two different radiographers was studied. The results were compared with the existing practice in paediatric chest radiography and the opportunities for optimization were identified in order to reduce patient doses. A methodology was developed for optimization of the x-ray examinations by grouping children in age groups or according to other appropriate indication and creating an algorithm for proper selection of the exposure parameters for each group. The algorithm for the optimisation of paediatric chest radiography reduced patient doses (PKA, organ dose, effective dose) between 1.5 and 6 times for the different age groups, the average glandular dose up to 10 times and the dose for the lung between 2 and 5 times. The resulting X-ray images were of good diagnostic quality. The subjectivity in the choice of exposure parameters was reduced and standardization has been achieved in the work of the radiographers. The role of the radiologist, the medical physicist and radiographer in the process of optimization was shown. It was proven the effect of teamwork in reducing patient doses at keeping adequate image quality. Key words: Chest Radiography. Paediatric Radiography. Optimization. Radiation Exposure. Radiation Protection

  17. Magnetic tomography within paediatric radiological diagnostics

    International Nuclear Information System (INIS)

    Smevik, Bjarne; Borthne, Arne

    2000-01-01

    Background: MRI is a promising imaging technique for diseases in most organ systems in children. Material and methods: this review discusses MRI on the basis of the literature and our own experience. Results: the value of MRI in paediatric neuroradiology is firmly established. In congenital heart defects and other reasons for cardiovascular imaging in children, the non-invasiveness of the method is appealing. MRI is already included in most international paediatric oncology protocols. Paediatric applications for MRI differ from those in adults as they focus on developmental and congenital abnormalities. Furthermore, some pathological conditions are unique to children. MRI is also a promising alternative to established methods for evaluation of the urinary tract. There are some specific problems with MRI in children. Immobilisation and sedation techniques include tight wrapping of the new-born with soft elastic bands, feeding immediately prior to the study and allowing one parent into the magnet with the child. Midazolam and oral chloral hydrate are usually used for sedation. Interpretation: MRI is of particular value in the paediatric age group as the method is capable of highly accurate imaging in a variety of congenital and paediatric diseases without the use of ionising radiation. Faster sequences and better resolution will further increase the use of MRI in children

  18. The proposal of Paediatric Virology and its perspectives: An interview with Professor of Paediatrics Maria Theodoridou.

    Science.gov (United States)

    Mammas, Ioannis N; Spandidos, Demetrios A

    2017-10-01

    Professor Maria Theodoridou, Emeritus Professor of Paediatrics at the University of Athens, is one of the few paediatricians in Greece, who have experienced almost all the infectious diseases of the second half of the 20th century and their severe consequences, prior to the widespread adoption of immunisations. A milestone during her career was the establishment of a specialised National Reference Unit for the care of paediatric patients with acquired immune deficiency syndrome (AIDS) at the 'Aghia Sophia' Children's Hospital in Athens, Greece. According to Professor Theodoridou, training on the prevention, management and treatment of neonatal and paediatric viral infections represents a new educational challenge for both community as well as hospital-based paediatric health professionals. The debate of the potential strategically principal role of Paediatric Virology subspecialists in the primary, secondary and tertiary clinical practice is definitely necessary and needs further discussion and evaluation, she adds. She describes the difficulties that Greece, a country under a long-standing financial crisis, faces for the hospital-based management of paediatric viral infections and refers to the future advances, which are expected in the field of diagnosis and treatment of viral infections in neonates and children. In the context of the 3rd Workshop on Paediatric Virology, which will be held in Athens on October 7th, 2017, Professor Theodoridou will focus on the immigration crisis and vaccination policy.

  19. Practical application of natriuretic peptides in paediatric cardiology

    DEFF Research Database (Denmark)

    Smith, Julie; Goetze, Jens Peter; B. Andersen, Claus

    2010-01-01

    It is still uncertain if cardiac natriuretic peptides are useful biomarkers in paediatric cardiology. In this review we identify four clinical scenarios in paediatric cardiology, where clinical decision-making can be difficult, and where we feel the paediatric cardiologists need additional...

  20. Oral medicines for children in the European paediatric investigation plans

    NARCIS (Netherlands)

    van Riet-Nales, Diana A; Römkens, Erwin G A W; Saint-Raymond, Agnes; Kozarewicz, Piotr; Schobben, Alfred F A M; Egberts, Toine C G; Rademaker, Carin M A

    2014-01-01

    INTRODUCTION: Pharmaceutical industry is no longer allowed to develop new medicines for use in adults only, as the 2007 Paediatric Regulation requires children to be considered also. The plans for such paediatric development called Paediatric Investigation Plans (PIPs) are subject to agreement by

  1. Fracture mechanics

    CERN Document Server

    Perez, Nestor

    2017-01-01

    The second edition of this textbook includes a refined presentation of concepts in each chapter, additional examples; new problems and sections, such as conformal mapping and mechanical behavior of wood; while retaining all the features of the original book. The material included in this book is based upon the development of analytical and numerical procedures pertinent to particular fields of linear elastic fracture mechanics (LEFM) and plastic fracture mechanics (PFM), including mixed-mode-loading interaction. The mathematical approach undertaken herein is coupled with a brief review of several fracture theories available in cited references, along with many color images and figures. Dynamic fracture mechanics is included through the field of fatigue and Charpy impact testing. Explains computational and engineering approaches for solving crack-related problems using straightforward mathematics that facilitate comprehension of the physical meaning of crack growth processes; Expands computational understandin...

  2. Fracture analysis

    International Nuclear Information System (INIS)

    Ueng, Tzoushin; Towse, D.

    1991-01-01

    Fractures are not only the weak planes of a rock mass, but also the easy passages for the fluid flow. Their spacing, orientation, and aperture will affect the deformability, strength, heat transmittal, and fluid transporting properties of the rock mass. To understand the thermomechanical and hydrological behaviors of the rock surrounding the heater emplacement borehole, the location, orientation, and aperture of the fractures of the rock mass should be known. Borehole television and borescope surveys were performed to map the location, orientation, and aperture of the fractures intersecting the boreholes drilled in the Prototype Engineered Barrier System Field Tests (PEBSFT) at G-Tunnel. Core logging was also performed during drilling. However, because the core was not oriented and the depth of the fracture cannot be accurately determined, the results of the core logging were only used as reference and will not be discussed here

  3. Facial Fractures.

    Science.gov (United States)

    Ricketts, Sophie; Gill, Hameet S; Fialkov, Jeffery A; Matic, Damir B; Antonyshyn, Oleh M

    2016-02-01

    After reading this article, the participant should be able to: 1. Demonstrate an understanding of some of the changes in aspects of facial fracture management. 2. Assess a patient presenting with facial fractures. 3. Understand indications and timing of surgery. 4. Recognize exposures of the craniomaxillofacial skeleton. 5. Identify methods for repair of typical facial fracture patterns. 6. Discuss the common complications seen with facial fractures. Restoration of the facial skeleton and associated soft tissues after trauma involves accurate clinical and radiologic assessment to effectively plan a management approach for these injuries. When surgical intervention is necessary, timing, exposure, sequencing, and execution of repair are all integral to achieving the best long-term outcomes for these patients.

  4. Peer teaching in paediatrics - medical students as learners and teachers on a paediatric course.

    Science.gov (United States)

    Schauseil-Zipf, Ulrike; Karay, Yassin; Ehrlich, Roland; Knoop, Kai; Michalk, Dietrich

    2010-01-01

    Peer assisted learning is known as an effective educational strategy in medical teaching. We established a peer assisted teaching program by student tutors with a focus on clinical competencies for students during their practical training on paediatric wards. It was the purpose of this study to investigate the effects of a clinical skills training by tutors, residents and consultants on students evaluations of the teaching quality and the effects of a peer teaching program on self assessed clinical competencies by the students. Medical student peers in their 6(th) year were trained by an intensive instruction program for teaching clinical skills by paediatric consultants, doctors and psychologists. 109 students in their 5(th) year (study group) participated in a peer assisted teaching program for training clinical skills in paediatrics. The skills training by student peer teachers were supervised by paediatric doctors. 45 students (control group) participated in a conventional paediatric skills training by paediatric doctors and consultants. Students from both groups, which were consecutively investigated, completed a questionnaire with an evaluation of the satisfaction with their practical training and a self assessment of their practical competencies. The paediatric skills training with student peer teachers received significantly better ratings than the conventional skills training by paediatric doctors concerning both the quality of the practical training and the support by the teaching medical staff. Self assessed learning success in practical skills was higher rated in the peer teaching program than in the conventional training. The peer assisted teaching program of paediatric skills training was rated higher by the students regarding their satisfaction with the teaching quality and their self assessment of the acquired skills. Clinical skills training by student peer teachers have to be supervised by paediatric doctors. Paediatric doctors seem to be more

  5. Diagnostic radiology in paediatric palliative care

    International Nuclear Information System (INIS)

    Patel, Preena; Koh, Michelle; Carr, Lucinda; McHugh, Kieran

    2014-01-01

    Palliative care is an expanding specialty within paediatrics, which has attracted little attention in the paediatric radiological literature. Paediatric patients under a palliative care team will have numerous radiological tests which we traditionally categorise under organ systems rather than under the umbrella of palliative medicine. The prevalence of children with life-limiting illness is significant. It has been estimated to be one per thousand, and this may be an underestimate. In this review, we will focus on our experience at one institution, where radiology has proven to be an invaluable partner to palliative care. We will discuss examples of conditions commonly referred to our palliative care team and delineate the crucial role of diagnostic radiology in determining treatment options. (orig.)

  6. Diagnostic radiology in paediatric palliative care

    Energy Technology Data Exchange (ETDEWEB)

    Patel, Preena; Koh, Michelle; Carr, Lucinda; McHugh, Kieran [Great Ormond Street Hospital, Radiology Department, London (United Kingdom)

    2014-01-15

    Palliative care is an expanding specialty within paediatrics, which has attracted little attention in the paediatric radiological literature. Paediatric patients under a palliative care team will have numerous radiological tests which we traditionally categorise under organ systems rather than under the umbrella of palliative medicine. The prevalence of children with life-limiting illness is significant. It has been estimated to be one per thousand, and this may be an underestimate. In this review, we will focus on our experience at one institution, where radiology has proven to be an invaluable partner to palliative care. We will discuss examples of conditions commonly referred to our palliative care team and delineate the crucial role of diagnostic radiology in determining treatment options. (orig.)

  7. Is paediatric trauma severity overestimated at triage?

    DEFF Research Database (Denmark)

    DO, H Q; Hesselfeldt, R; Steinmetz, J

    2014-01-01

    BACKGROUND: Severe paediatric trauma is rare, and pre-hospital and local hospital personnel experience with injured children is often limited. We hypothesised that a higher proportion of paediatric trauma victims were taken to the regional trauma centre (TC). METHODS: This is an observational...... follow-up study that involves one level I TC and seven local hospitals. We included paediatric (trauma patients with a driving distance to the TC > 30 minutes. The primary end-point was the proportion of trauma patients arriving in the TC. RESULTS: We included 1934...... trauma patients, 238 children and 1696 adults. A total of 33/238 children (13.9%) vs. 304/1696 adults (17.9%) were transported to the TC post-injury (P = 0.14). Among these, children were significantly less injured than adults [median Injury Severity Score (ISS) 9 vs. 14, P 

  8. Pisiform fractures

    International Nuclear Information System (INIS)

    Fleege, M.A.; Jebson, P.J.; Renfrew, D.L.; El-Khoury, G.Y.; Steyers, C.M. Jr.

    1991-01-01

    Fractures of the pisiform are often missed due to improper radiographic evaluation and a tendency to focus on other, more obvious injuries. Delayed diagnosis may result in disabling sequelae. A high index of clinical suspicion and appropriate radiographic examination will establish the correct diagnosis. Ten patients with pisiform fracture are presented. The anatomy, mechanism of injury, clinical presentation, radiographic features, and evaluation of this injury are discussed. (orig.)

  9. Stress fractures

    International Nuclear Information System (INIS)

    Berquist, T.H.; Cooper, K.L.; Pritchard, D.J.

    1985-01-01

    The diagnosis of a stress fracture should be considered in patients presented with pain after a change in activity, especially if the activity is strenuous and the pain is in the lower extremities. Since evidence of the stress fracture may not be apparent for weeks on routine radiographs, proper use of other imaging techniques will allow an earlier diagnosis. Prompt diagnosis is especially important in the femur, where displacement may occur

  10. Virtual colonoscopy in paediatric patients

    International Nuclear Information System (INIS)

    Carrascosa, Patricia; Lopez, Elba Martin; Capunay, Carlos; Vallejos, Javier; Carrascosa, Jorge

    2010-01-01

    Objective: To determine the usefulness of perspective-filet view for polypoid lesions in paediatric patients in comparison with conventional virtual colonoscopy (VC) analysis and optical colonoscopy. Methods: Sixty-one patients (mean age 5 years old) with a previous episode of rectal bleeding were studied using a 16 slices CT scanner. All patients underwent a colonic preparation. Two acquisitions were done in supine and prone positions with slices of 2 mm thickness; increment 1 mm, 30-50 mA; 90-120 kV. In a workstation an experienced radiologist reviewed images twice. The first read was done using the conventional virtual colonoscopy technique with the evaluation of two-dimensional (2D), three-dimensional (3D) and endoscopical images. Later, in a second session, perspective-filet view was used. It shows a 360 deg. unrolled visualization of the inner colon. The presence, size and location of the lesions were determined. A record of the reading time was made. Results: At per patient evaluation the conventional virtual colonoscopy analysis obtained a sensitivity of 86% and a specificity of 98%. The perspective-filet view obtained a sensitivity of 91% and a specificity of 99%. In the evaluation on a per lesion basis the conventional analysis had a sensitivity of 81% and a specificity of 88%. Perspective-filet view, had a sensitivity of 82% and specificity of 90%. The average total reading time using conventional colonoscopy technique was 18 ± 3 min, versus 4 ± 1 min using the perspective-filet view. Conclusion: Virtual colon dissection with perspective-filet view is more time-efficient than conventional virtual colonoscopy evaluation with correct correlation in results.

  11. Paediatric Radiation Oncology. Chapter 21

    International Nuclear Information System (INIS)

    Anacak, Y.; Zaghloul, M.; Laskar, S.

    2017-01-01

    Although cancer is a typical disease of ageing adults, it can be seen at any age and cancer diagnosis in a child is not a rare situation. Every day around the world, many teenagers, young children and even infants are diagnosed with cancer. Cancer in children is an important health care problem, not only for the individual patient and medical staff, but also for families, teachers, friends and society as a whole. In every culture, children are considered innocent human beings and the diagnosis of such an ‘evil’ disease in a young child always induces feelings of unfairness and anguish. Most childhood cancers are curable; using the best treatment options, more than 80% of children with cancer may survive to adulthood. However, cure alone is not the ultimate goal for paediatric cancer treatment; late effects of treatment impact the quality of life of patients. Cure from cancer in a child means adding at least 50–60 years to his or her life, which is long enough to develop serious late effects of the treatment and the induction of secondary cancers. Thus, treatment should be tailored to minimize the exposure of healthy tissues to chemotherapy drugs and radiation. Cancer treatment can be a painful process, often involving surgery, radiotherapy and chemotherapy, and requiring very long treatment periods, which impair the motor and mental development of the child, and his or her educational activities and relations with society. Childhood cancer survivors sometimes have modest to severe sequelae of the disease itself and the treatment used, which may disrupt their development to a healthy adulthood. These cancer survivors should be fully integrated into society and be allowed to live productive lives even when lifelong rehabilitation is required to keep them active.

  12. Retinal detachment in paediatric patients

    International Nuclear Information System (INIS)

    Zafar, S. N.; Qureshi, N.; Azad, N.; Khan, A.

    2013-01-01

    Objective: To assess the causes of retinal detachment in children and the various operative procedures requiring vitreoretinal surgical intervention for the same. Study Design: Case series. Place and Duration of Study: Department of Ophthalmology, Al-Shifa Trust Eye Hospital, Rawalpindi, from January 2006 to May 2009. Methodology: A total of 281 eyes of 258 patients, (aged 0 - 18 years) who underwent vitreo-retinal surgical intervention for retinal detachment were included. Surgical log was searched for the type of retinal detachment and its causes. Frequencies of various interventions done in these patients viz. vitrectomy, scleral buckle, use of tamponading agents, laser photocoagulation and cryotherapy were noted. Results were described as descriptive statistics. Results: Myopia was the cause in 62 (22.1%) and trauma in 51 (18.1%) of the eyes. Total retinal detachment (RD) was treated in 94 (33.5%) eyes, sub total RD in 36 (12.8%), recurrent RD in 32 (11.4%), giant retinal tear in 28 (10%), tractional RD in 15 (5.3%) and exudative RD in 2 (0.7%). Prophylactic laser or cryotherapy was applied in 74 (26.3%) of the eyes. Pars plana vitrectomy (PPV) was carried out in 159 (56.6%) eyes while scleral buckle procedure was done in 129 (45.9%) eyes. Silicon oil was used in 149 (53%), perfluorocarbon liquid in 32 (11.4%) and gas tamponade in 20 (7.1%) eyes. Conclusion: The most common cause of retinal detachment in paediatric patients was myopia, followed by trauma. Total RD was more common as compared to the other types. The most common procedure adopted was pars plana vitrectomy followed by scleral buckle procedure. (author)

  13. Radiological protection of paediatric patients: An overview

    International Nuclear Information System (INIS)

    Ringertz, H.G.; Bremmer, S.

    2001-01-01

    Paediatric patients require special attention with respect to radiation protection, for various reasons. The difference between a 1 kg premature baby and a 100 kg teenager puts special demands on the radiographic techniques used, and the increased radiosensitivity of growing tissue and the patients' longer life expectancy put greater demands on the justification of the procedures to be carried out. The optimization procedure involves practical aspects such as immobilization, body build specific exposure parameters and body build specific anatomical knowledge. These and other aspects of paediatric radiological protection are discussed in this overview. (author)

  14. A disjointed effort: paediatric musculoskeletal examination.

    LENUS (Irish Health Repository)

    Gill, Irwin

    2012-07-01

    Musculoskeletal (MSK) symptoms are a frequent cause of emergency department attendance for children, and while most often indicative of benign or self-limiting disease, such symptoms can occasionally be the first presentation of serious illness such as leukaemia or juvenile idiopathic arthritis. MSK examination, however, is often not included as part of the routine paediatric examination. The authors aimed to evaluate how often and how thoroughly MSK examination was performed during admissions to the paediatric ward and to compare it with the examination of other symptoms in relation to the presenting complaint and eventual diagnosis.

  15. Scaphoid Fracture

    Directory of Open Access Journals (Sweden)

    Esther Kim, BS

    2018-04-01

    Full Text Available History of present illness: A 25-year-old, right-handed male presented to the emergency department with left wrist pain after falling from a skateboard onto an outstretched hand two-weeks prior. He otherwise had no additional concerns, including no complaints of weakness or loss of sensation. On physical exam, there was tenderness to palpation within the anatomical snuff box. The neurovascular exam was intact. Plain films of the left wrist and hand were obtained. Significant findings: The anteroposterior (AP plain film of this patient demonstrates a full thickness fracture through the middle third of the scaphoid (red arrow, with some apparent displacement (yellow lines and subtle angulation of the fracture fragments (blue line. Discussion: The scaphoid bone is the most commonly fractured carpal bone accounting for 70%-80% of carpal fractures.1 Classically, it is sustained following a fall onto an outstretched hand (FOOSH. Patients should be evaluated for tenderness with palpation over the anatomical snuffbox, which has a sensitivity of 100% and specificity of 40%.2 Plain films are the initial diagnostic modality of choice and have a sensitivity of 70%, but are commonly falsely negative in the first two to six weeks of injury (false negative of 20%.3 The Mayo classification organizes scaphoid fractures as involving the proximal, mid, and distal portions of the scaphoid bone with mid-fractures being the most common.3 The proximal scaphoid is highly susceptible to vascular compromise because it depends on retrograde blood flow from the radial artery. Therefore, disruption can lead to serious sequelae including osteonecrosis, arthrosis, and functional impairment. Thus, a low threshold should be maintained for neurovascular evaluation and surgical referral. Patients with non-displaced scaphoid fractures should be placed in a thumb spica splint.3 Patients with even suspected scaphoid fractures should be placed in a thumb spica splint and re

  16. Rib fractures after chest physiotherapy for bronchiolitis or pneumonia in infants

    Energy Technology Data Exchange (ETDEWEB)

    Chalumeau, Martin [Service de Pneumologie et d' Allergologie Pediatriques, Hopital Necker-Enfants Malades, Paris (France); Service de Pediatrie, Hopital Saint-Vincent-de-Paul, Paris (France); Foix-l' Helias, Laurence; Scheinmann, Pierre; Zuani, Pierre [Service de Pneumologie et d' Allergologie Pediatriques, Hopital Necker-Enfants Malades, Paris (France); Gendrel, Dominique [Service de Pediatrie, Hopital Saint-Vincent-de-Paul, Paris (France); Ducou-le-Pointe, Hubert [Service de Radiologie, Hopital d' Enfants Armand-Trousseau, Avenue du Docteur Arnold Netter, 75571 Paris Cedex 12 (France)

    2002-09-01

    Heading AbstractBackground. The reported causes of rib fractures in infants are: child abuse, accidental injury, cardiopulmonary resuscitation, bone fragility, birth trauma and severe cough.Objective. To report chest physiotherapy (CPT) as a new cause of rib fractures in five infants.Materials and methods. We retrospectively identified all infants with rib fractures after CPT for bronchiolitis or pneumonia over a 4-year period in two paediatric and one paediatric radiology units in three university hospitals in Paris.Results. Five boys were identified. Their median age was 3 months. None had any other potential cause of rib fractures. The indication for CPT was bronchiolitis in four cases and pneumonia in one. The median number of rib fractures was four (range 1-5). Fractures were located between the 3rd and 8th ribs; they were lateral in four patients and posterior in one; they were unilateral in four patients and bilateral in one. Evolution was favourable in all cases. The prevalence of rib fractures after CPT during the study period was estimated at 1 in 1,000 infants hospitalised for bronchiolitis or pneumonia.Conclusions. CPT should be considered a potential, but very rare cause of rib fractures in infants. It can be of clinical relevance when rib fractures are the only feature suggestive of child abuse. (orig.)

  17. Rib fractures after chest physiotherapy for bronchiolitis or pneumonia in infants

    International Nuclear Information System (INIS)

    Chalumeau, Martin; Foix-l'Helias, Laurence; Scheinmann, Pierre; Zuani, Pierre; Gendrel, Dominique; Ducou-le-Pointe, Hubert

    2002-01-01

    Heading AbstractBackground. The reported causes of rib fractures in infants are: child abuse, accidental injury, cardiopulmonary resuscitation, bone fragility, birth trauma and severe cough.Objective. To report chest physiotherapy (CPT) as a new cause of rib fractures in five infants.Materials and methods. We retrospectively identified all infants with rib fractures after CPT for bronchiolitis or pneumonia over a 4-year period in two paediatric and one paediatric radiology units in three university hospitals in Paris.Results. Five boys were identified. Their median age was 3 months. None had any other potential cause of rib fractures. The indication for CPT was bronchiolitis in four cases and pneumonia in one. The median number of rib fractures was four (range 1-5). Fractures were located between the 3rd and 8th ribs; they were lateral in four patients and posterior in one; they were unilateral in four patients and bilateral in one. Evolution was favourable in all cases. The prevalence of rib fractures after CPT during the study period was estimated at 1 in 1,000 infants hospitalised for bronchiolitis or pneumonia.Conclusions. CPT should be considered a potential, but very rare cause of rib fractures in infants. It can be of clinical relevance when rib fractures are the only feature suggestive of child abuse. (orig.)

  18. ANESTESIA PARA AMPUTACIÓN SUPRACONDÍLEA EN PACIENTE CON SÍNDROME CORONARIO AGUDO / Anesthesia for supracondylar amputation in patient with acute coronary syndrome

    Directory of Open Access Journals (Sweden)

    Marilyn Ramírez Méndez

    2012-03-01

    Full Text Available Resumen La insuficiencia arterial periférica es una enfermedad que se asocia a factores de riesgo aterogénico reconocidos, y es más frecuente en personas con hiperlipidemia, diabetes mellitus y hábito de fumar. Se presenta el caso de una mujer de 67 años de edad, con antecedentes de hipertensión arterial, diabetes mellitus e infarto de miocardio antiguo, que ingresa por signos de inflamación aguda del miembro inferior derecho como consecuencia de una insuficiencia arterial periférica. A los 8 días del ingreso presentó un síndrome coronario agudo sin elevación del segmento ST, con fallo de bomba Killip II, y una vez compensada fue anunciada para amputación supracondílea de urgencia, debido a una gangrena isquémica. Se decidió utilizar anestesia espinal subaracnoidea selectiva del miembro inferior derecho, a cual se aplicó sin complicaciones y favoreció el adecuado desarrollo de la cirugía planificada. A las 72 horas la paciente fue egresada de la UCI, sin síntomas cardiovasculares y compensación metabólica. / Abstract Peripheral arterial insufficiency is a disease that is associated with known atherogenic risk factors, and is more common in people with hyperlipidemia, diabetes mellitus and smoking habit. A case of a 67-year-old woman with a history of hypertension, diabetes mellitus and old myocardial infarction is presented. She was admitted for signs of acute inflammation of the right leg due to peripheral arterial insufficiency. 8 days after admission she presented an acute coronary syndrome without ST segment elevation with pump failure (Killip class II, and once compensated she was scheduled for emergency supracondylar amputation due to ischemic gangrene. It was decided to use selective spinal subarachnoid from the right leg, which was applied without complications and favored the proper development of the planned surgery. At 72 hours, the patient was discharged from the ICU, with metabolic compensation and without

  19. Morbidity among Israeli paediatric travellers.

    Science.gov (United States)

    Rabinowicz, Shira; Schwartz, Eli

    2017-09-01

    International travel, particularly to developing countries, is becoming increasingly common among the Israeli population, including an increase in the number of travelling children. Since children are a distinct travellers' population, data about their post-travel morbidity are needed. A retrospective study which examined all children (0-19 years old) who presented to our centre after international travel from 1999 to 2015. About 314 children were seen. The mean age was 10 years (SD ± 5.8). Most of the patients (80.6%) were tourists, and the rest were expatriates. The main destinations visited were South-Asia (46.5%), Sub-Saharan Africa (33.4%), Latin-America (7%) and Europe (6.4%). Overall, the most common diagnoses were gastrointestinal (GI) (mainly chronic) disorders (30.6%), followed by febrile diseases (26.4%), among which 18.1% of patients were diagnosed with dengue fever and 12% with malaria. Dermatologic conditions accounted for 25.2%. Additional diagnoses were schistosomiasis (6.4%) and neuropsychiatric symptoms (2.2%). A substantial part, 10.8%, had eosinophilia, either symptomatic or asymptomatic. Travellers to Asia, compared to travellers to Africa, presented more commonly with GI illness (OR 2.02, 95% confidence interval 1.13-3.61), and dermatologic conditions (OR 1.94, 95% confidence interval 1.05-3.61). Morbidity was associated with a variety of transmission modes, such as food-borne illnesses (30.9%), bite and sting wounds (10.2%), mosquito-borne infections (8%), freshwater contact (6.7%) and tick-borne infections (2.2%). The main conditions seen in paediatric returning travellers were GI, febrile and dermatologic illnesses, some may be rare in their country of origin. Targeting care for the suspected pathogens based on updated knowledge of epidemiology and thorough travel history is essential. © International Society of Travel Medicine, 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

  20. Paediatric Neurological Conditions Seen at the Physiotherapy ...

    African Journals Online (AJOL)

    Paediatric neurological conditions constitute a major cause of disability in childhood. However there seems to be an apparent dearth of published works on the patterns of neurological conditions seen in Nigerian physiotherapy clinics of rural locations. This study aimed at describing the spectrum of neurological conditions ...

  1. Ingested foreign bodies in the paediatric patient.

    LENUS (Irish Health Repository)

    O'Brien, G C

    2012-02-03

    BACKGROUND: Paediatric foreign body (FB) ingestion is a common problem and while most can be managed conservatively, a sub-population require intervention. AIMS: To establish clear guidelines for management of paediatric FB ingestion. METHODS: A retrospective chart review analysing all paediatric admissions with FB ingestion over a 10-year period from 1990 to 1999. RESULTS: Of 339 patients presenting to the accident and emergency department with FB ingestion, 59 required admission. Ingestion was accidental in 93.0% of patients. The reasons for admission were as follows: large FBs; dangerous FBs; and living far from the hospital. Nineteen patients (32.2%) were discharged without intervention. Thirty-seven (62.7%) required endoscopic retrieval. In two, the FB was not identified at endoscopy. Only three (5%) required surgery. CONCLUSION: Conservative management of FB ingestion in the paediatric population is possible in the majority of cases. However, a minority require intervention. While guidelines for intervention are ill-defined, definitive indications include symptomatic patients, or dangerous objects.

  2. Onset symptoms in paediatric multiple sclerosis

    DEFF Research Database (Denmark)

    Boesen, Magnus Spangsberg; Sellebjerg, Finn; Blinkenberg, Morten

    2014-01-01

    : 66-100%) of paediatric MS subjects, 77% (CI: 46-95%) had an elevated IgG index and 85% (CI: 55-98%) had oligoclonal bands in the cerebrospinal fluid. MRI showed characteristic white matter lesions in all children (CI: 80-100%). CONCLUSION: MS symptoms at the first demyelinating event and diagnostic...

  3. Whole-body MRI in paediatric oncology

    NARCIS (Netherlands)

    Nievelstein, Rutger A J; Littooij, Annemieke S.

    Imaging plays a crucial role in the diagnosis and follow-up of paediatric malignancies. Until recently, computed tomography (CT) has been the imaging technique of choice in children with cancer, but nowadays there is an increasing interest in the use of functional imaging techniques like positron

  4. Gonad protection for the paediatric patient

    International Nuclear Information System (INIS)

    Gyll, C.

    1988-01-01

    A brief article gives examples of hip radiographs of paediatric patients showing misplacement of shields for gonad protection. Shields cut out of lead-PVC sheeting or the fenestration method of shielding are proposed as more successful methods of gonad shielding. (UK)

  5. What?s New in Paediatric Sepsis

    OpenAIRE

    Farrell, Deborah; Nadel, Simon

    2016-01-01

    Severe sepsis and septic shock remains a leading cause of mortality and morbidity in children. There is ongoing uncertainty regarding the optimal treatment pathways however the initial management of sepsis is crucial. This article is designed to be an informal and personal review of recent developments in paediatric sepsis over the past 3?years.

  6. Clinician's gaze behaviour in simulated paediatric emergencies.

    Science.gov (United States)

    McNaughten, Ben; Hart, Caroline; Gallagher, Stephen; Junk, Carol; Coulter, Patricia; Thompson, Andrew; Bourke, Thomas

    2018-03-07

    Differences in the gaze behaviour of experts and novices are described in aviation and surgery. This study sought to describe the gaze behaviour of clinicians from different training backgrounds during a simulated paediatric emergency. Clinicians from four clinical areas undertook a simulated emergency. Participants wore SMI (SensoMotoric Instruments) eye tracking glasses. We measured the fixation count and dwell time on predefined areas of interest and the time taken to key clinical interventions. Paediatric intensive care unit (PICU) consultants performed best and focused longer on the chest and airway. Paediatric consultants and trainees spent longer looking at the defibrillator and algorithm (51 180 ms and 50 551 ms, respectively) than the PICU and paediatric emergency medicine consultants. This study is the first to describe differences in the gaze behaviour between experts and novices in a resuscitation. They mirror those described in aviation and surgery. Further research is needed to evaluate the potential use of eye tracking as an educational tool. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  7. A review of paediatric tuberculosis in Denmark

    DEFF Research Database (Denmark)

    Hatleberg, Camilla; Prahl, Julie B; Rasmussen, Jeppe Nørgaard

    2014-01-01

    Paediatric tuberculosis (TB) is a key indicator for recent transmission and presents a reservoir for the disease. We describe trends in epidemiology, microbiological characteristics and treatment outcome in Denmark between 2000 and 2009. Data was retrieved from the national TB surveillance system...

  8. Paediatric organophosphate poisoning - a rural hospital experience ...

    African Journals Online (AJOL)

    Objectives. To document the presentation and course of organophosphate poisoning (OPP) in children and to record the frequency of atropine toxicity during treatment. Design. A retrospective observational study was conducted of all recorded paediatric cases of OPP admitted to a regional hospital over a 5-year period from ...

  9. STUDY ON NONINFECTIOUS DERMATOSES IN PAEDIATRIC AGE

    Directory of Open Access Journals (Sweden)

    Ananthi Mahalingam

    2017-09-01

    Full Text Available BACKGROUND Paediatric dermatology is a unique subspecialty in that child is not a miniature adult. Paediatric dermatoses differ from that of the adults in clinical presentation, treatment and prognosis. Various studies from India have shown infections and infestations to be the most common paediatric dermatoses. This study was planned to determine the epidemiological pattern of common noninfectious dermatoses in our paediatric patients as no such data are available from this part of the country. A cross-sectional study was undertaken to study the prevalence of the noninfectious dermatoses in all the new paediatric patients attending the Skin Outpatient Department (OPD at Villupuram Medical College over a period of three years. MATERIALS AND METHODS A total number of 550 children in the age group ranging from newborn to 12 years with noninfectious dermatoses attending the OPD for the first time were enrolled in the study. RESULTS Physiological changes of skin was the most common dermatoses in the newborn age group, while eczema was the most common dermatoses in infants, preschool and school going children. In the infants, eczema was followed by pigmentary disorders, mongolian spots, vascular nevi, ichthyosis, epidermolysis bullosa, alopecia areata and papular urticaria in the order of prevalence. Among preschool going children, eczema was followed by papular urticaria, papulosquamous disorders, pigmentary disorders, hair disorders, nevi, drug reactions, keratinisation disorders, urticaria, etc. In the school going age group, eczema was followed by papulosquamous disorders, pigmentary disorders, papular urticaria, nutritional disorders, ichthyosis, nevi, miliaria, drug reaction, hair disorders, photodermatoses, urticaria, collagen vascular disease and vascular nevi in the order of prevalence. CONCLUSION Eczema, papulosquamous disorders, papular urticaria, pigmentary disorders seem to be the most common noninfectious dermatoses in children. However

  10. The delivery of general paediatric surgery in Ireland: a survey of higher surgical trainees.

    LENUS (Irish Health Repository)

    Boyle, E

    2012-12-01

    The delivery of general paediatric surgery is changing in Ireland. Fewer paediatric surgical procedures are being performed by newly appointed consultant general surgeons, resulting in increased referrals to the specialist paediatric surgeons of uncomplicated general paediatric surgical problems. We surveyed current higher surgical trainees about their views on provision of paediatric surgical services.

  11. Trochanteric fractures

    International Nuclear Information System (INIS)

    Herrlin, K.; Stroemberg, T.; Lidgren, L.; Walloee, A.; Pettersson, H.; Lund Univ.

    1988-01-01

    Four hundred and thirty trochanteric factures operated upon with McLaughlin, Ender or Richard's osteosynthesis were divided into 6 different types based on their radiographic appearance before and immediately after reposition with special reference to the medial cortical support. A significant correlation was found between the fracture type and subsequent mechanical complications where types 1 and 2 gave less, and types 4 and 5 more complications. A comparison of the various osteosyntheses showed that Richard's had significantly fewer complications than either the Ender or McLaughlin types. For Richard's osteosynthesis alone no correlation to fracture type could be made because of the small number of complications in this group. (orig.)

  12. Fracture Blisters

    Directory of Open Access Journals (Sweden)

    Uebbing, Claire M

    2011-02-01

    Full Text Available Fracture blisters are a relatively uncommon complication of fractures in locations of the body, such as the ankle, wrist elbow and foot, where skin adheres tightly to bone with little subcutaneous fat cushioning. The blister that results resembles that of a second degree burn.These blisters significantly alter treatment, making it difficult to splint or cast and often overlying ideal surgical incision sites. Review of the literature reveals no consensus on management; however, most authors agree on early treatment prior to blister formation or delay until blister resolution before attempting surgical correction or stabilization. [West J Emerg Med. 2011;12(1;131-133.

  13. Elbow Fractures

    Science.gov (United States)

    ... is also an important factor when treating elbow fractures. Casts are used more frequently in children, as their risk of developing elbow stiffness is small; however, in an adult, elbow stiffness is much more likely. Rehabilitation directed by your doctor is often used to ...

  14. Wrist Fractures

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is a Hand Therapist? Media Find a Hand Surgeon Home Anatomy Wrist Fractures Email to a friend * required fields ...

  15. Shoulder Fractures

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is a Hand Therapist? Media Find a Hand Surgeon Home Anatomy Shoulder Fractures Email to a friend * required fields ...

  16. Dosimetry in Diagnostic Radiology for Paediatric Patients

    International Nuclear Information System (INIS)

    2013-01-01

    Concern about the radiation dose to children from diagnostic radiology examinations has recently been popularly expressed, particularly as related to computed tomography (CT) procedures. This involves the observation that children can receive doses far in excess of those delivered to adults, in part due to the digital nature of the image receptors that may give no warning to the operator of the dose to the patient. Concern for CT examinations should be extended to the broad range of paediatric diagnostic radiological procedures responsible for radiation doses in children, especially as factors, such as increased radiosensitivity and the longer life expectancy of children, increase the associated radiation risk. In all cases, owing to the added paediatric radiological examination factor of patient size and its associated impact on equipment selection, clinical examination protocol and dosimetric audit, the determination of paediatric dose requires a distinct approach from adult dosimetry associated with diagnostic radiological examinations. In response to this, there is a need to inform health professionals about standardized methodologies used to determine paediatric dose for all major modalities such as general radiography, fluoroscopy and CT. Methodologies for standardizing the conduct of dose audits and their use for the derivation and application of diagnostic reference levels for patient populations, that vary in size, are also required. In addition, a review is needed of the current knowledge on risks specific to non-adults from radiation, and also an analysis of the management of factors contributing to dose from paediatric radiological examinations. In 2007, the IAEA published a code of practice, Dosimetry in Diagnostic Radiology: An International Code of Practice, as Technical Reports Series No. 457 (TRS 457). TRS 457 recommends procedures for dosimetric measurement and calibration for the attainment of standardized dosimetry, and addresses requirements

  17. Paediatric conscious sedation: views and experience of specialists in paediatric dentistry.

    Science.gov (United States)

    Woolley, S M; Hingston, E J; Shah, J; Chadwick, B L

    2009-09-26

    The objectives were three-fold: to investigate the level of conscious sedation training received prior to and during specialist training in paediatric dentistry; to establish the use of conscious sedation during and following specialisation; and to determine the attitudes of specialists in paediatric dentistry to conscious sedation. A self-administered postal questionnaire was sent to all specialists in paediatric dentistry registered with the General Dental Council in January 2008. Non-responders were contacted again after a four-week period. A response rate of 60% was achieved. Of the 122 respondents, 67 (55%) had received sedation training as an undergraduate; 89 (75%) had been trained during specialisation. All respondents performed dental treatment under sedation as a trainee and the majority used nitrous oxide inhalation sedation (NOIS). Over 90% of respondents felt that NOIS should be available to all children, both in appropriate primary care settings and in hospitals. One hundred and twenty-one (99%) respondents thought that all trainees in paediatric dentistry should have sedation training. The most popular form of sedation amongst specialists in paediatric dentistry was NOIS. However, some of the respondents felt that children should have access to other forms of sedation in both the primary care and hospital settings. Additional research on other forms of sedation is required to evaluate their effectiveness and safety.

  18. Bimalleolar ankle fracture with proximal fibular fracture

    NARCIS (Netherlands)

    Colenbrander, R. J.; Struijs, P. A. A.; Ultee, J. M.

    2005-01-01

    A 56-year-old female patient suffered a bimalleolar ankle fracture with an additional proximal fibular fracture. This is an unusual fracture type, seldom reported in literature. It was operatively treated by open reduction and internal fixation of the lateral malleolar fracture. The proximal fibular

  19. [Efficacy of treatment with I(131) in paediatric Graves disease].

    Science.gov (United States)

    Enes Romero, P; Martín-Frías, M; de Jesús, M; Caballero Loscos, C; Alonso Blanco, M; Barrio Castellanos, R

    2014-01-01

    Radioiodine is an important therapeutic option in young patients with Grave's disease (GD). In the United States it is a widespread therapy, but in Europe its use in paediatrics is still controversial. To report our experience in radioiodine therapy of paediatric GD patients and analyse its effectiveness and safety. We retrospectively studied our paediatric population (de Pediatría. Published by Elsevier Espana. All rights reserved.

  20. Magnetic resonance imaging protocols for paediatric neuroradiology

    International Nuclear Information System (INIS)

    Saunders, Dawn E.; Thompson, Clare; Gunny, Roxanne; Jones, Rod; Cox, Tim; Chong, Wui Khean

    2007-01-01

    Increasingly, radiologists are encouraged to have protocols for all imaging studies and to include imaging guidelines in care pathways set up by the referring clinicians. This is particularly advantageous in MRI where magnet time is limited and a radiologist's review of each patient's images often results in additional sequences and longer scanning times without the advantage of improvement in diagnostic ability. The difficulties of imaging small children and the challenges presented to the radiologist as the brain develops are discussed. We present our protocols for imaging the brain and spine of children based on 20 years experience of paediatric neurological MRI. The protocols are adapted to suit children under the age of 2 years, small body parts and paediatric clinical scenarios. (orig.)

  1. Improving Treatment Response for Paediatric Anxiety Disorders

    DEFF Research Database (Denmark)

    Ege, Sarah; Reinholdt-Dunne, Marie Louise

    2016-01-01

    Cognitive behavioural therapy (CBT) is considered the treatment of choice for paediatric anxiety disorders, yet there remains substantial room for improvement in treatment outcomes. This paper examines whether theory and research into the role of information-processing in the underlying psychopat......Cognitive behavioural therapy (CBT) is considered the treatment of choice for paediatric anxiety disorders, yet there remains substantial room for improvement in treatment outcomes. This paper examines whether theory and research into the role of information-processing in the underlying...... interpretational biases, evidence regarding the effects of CBT on attentional biases is mixed. Novel treatment methods including attention bias modification training, attention feedback awareness and control training, and mindfulness-based therapy may hold potential in targeting attentional biases, and thereby...

  2. Paediatric doses from diagnostic radiology in Victoria

    International Nuclear Information System (INIS)

    Boal, T.J.; Cardillo, I.; Einsiedel, P.F.

    1998-01-01

    This study examines doses to paediatric patients from diagnostic radiology. Measurements were made at 29 hospitals and private radiology practices in the state of Victoria. Entrance skin doses in air were measured for the exposure factors used by hospital radiology departments and private radiology practices for a standard size 1, 5, 10 and 15 year old child, for the following procedures: chest AP/PA, lat; abdomen AP; pelvis AP; lumbar spine AP, lat; and skull AP, lat. There was a large range of doses for each particular procedure and age group. Factors contributing to the range of doses were identified. Guidance levels for paediatric radiology based on the third quartile value of the skin entrance doses have been recommended and are compared with guidance levels. Copyright (1998) Australasian Physical and Engineering Sciences in Medicine

  3. Action, prevention and epidemiology of paediatric obesity

    DEFF Research Database (Denmark)

    Lissau, Inge

    2005-01-01

    prevention studies, all of which are performed outside Denmark. Thus, this paper is not a classical review but rather a highlight of some aspects that the author finds important. The latest Danish national figures show a marked increase in the prevalence of obesity, especially among young men-a sevenfold...... regarding a national action plan against obesity. CONCLUSION: This paper highlights some important aspects of the epidemiology, prevention and actions in the field of paediatric obesity with special focus on Denmark.......UNLABELLED: The overall aim of this paper is to describe important issues regarding paediatric obesity as a public health problem. This paper focuses on actions taken, and on the prevalence of obesity in children, teens and adults in Denmark. In addition, the paper describes some important...

  4. Alternative diagnoses at paediatric appendicitis MRI

    International Nuclear Information System (INIS)

    Moore, M.M.; Kulaylat, A.N.; Brian, J.M.; Khaku, A.; Hulse, M.A.; Engbrecht, B.W.; Methratta, S.T.; Boal, D.K.B.

    2015-01-01

    As the utilization of MRI in the assessment for paediatric appendicitis increases in clinical practice, it is important to recognize alternative diagnoses as the cause of abdominal pain. The purpose of this review is to share our institution's experience using MRI in the evaluation of 510 paediatric patients presenting with suspected appendicitis over a 30 month interval (July 2011 to December 2013). An alternative diagnosis was documented in 98/510 (19.2%) patients; adnexal pathology (6.3%, n = 32), enteritis–colitis (6.3%, n = 32), and mesenteric adenitis (2.2%, n = 11) comprised the majority of cases. These common entities and other less frequent illustrative cases obtained during our overall institutional experience with MRI for suspected appendicitis are reviewed

  5. Hand decontamination practices in paediatric wards

    Directory of Open Access Journals (Sweden)

    S Jelly

    2003-09-01

    Full Text Available The purpose of this study was to determine and describe hand decontamination practices of health care professionals in the paediatric wards of an academic hospital in Johannesburg. The purpose was addressed within a survey design and through the use of descriptive and comparative methods. Data were collected through direct observation conducted with the use of a researcher-administered checklist. A sample of sixtysix health professionals was obtained through convenience sampling.

  6. Recent advances in paediatric respiratory medicine.

    Science.gov (United States)

    Turnbull, Andrew; Balfour-Lynn, Ian M

    2016-02-01

    This review highlights important advances in paediatric respiratory medicine since 2014, excluding cystic fibrosis. It focuses mainly on the more common conditions, bronchopulmonary dysplasia, bronchiolitis and preschool wheezing, asthma, pneumonia and sleep, and highlights some of the rarer conditions such as primary ciliary dyskinesia and interstitial lung disease (ILD). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  7. Fracture mechanics

    International Nuclear Information System (INIS)

    Miannay, D.P.

    1995-01-01

    This book entitle ''Fracture Mechanics'', the first one of the monograph ''Materiologie'' is geared to design engineers, material engineers, non destructive inspectors and safety experts. This book covers fracture mechanics in isotropic homogeneous continuum. Only the monotonic static loading is considered. This book intended to be a reference with the current state of the art gives the fundamental of the issues under concern and avoids the developments too complicated or not yet mastered for not making reading cumbersome. The subject matter is organized as going from an easy to a more complicated level and thus follows the chronological evolution in the field. Similarly the microscopic scale is considered before the macroscopic scale, the physical understanding of phenomena linked to the experimental observation of the material preceded the understanding of the macroscopic behaviour of structures. In this latter field the relatively recent contribution of finite element computations with some analogy with the experimental observation is determining. However more sensitive analysis is not skipped

  8. A paediatric cardiopulmonary resuscitation training project in Honduras.

    Science.gov (United States)

    Urbano, Javier; Matamoros, Martha M; López-Herce, Jesús; Carrillo, Angel P; Ordóñez, Flora; Moral, Ramón; Mencía, Santiago

    2010-04-01

    It is possible that the exportation of North American and European models has hindered the creation of a structured cardiopulmonary resuscitation (CPR) training programme in developing countries. The objective of this paper is to describe the design and present the results of a European paediatric and neonatal CPR training programme adapted to Honduras. A paediatric CPR training project was set up in Honduras with the instructional and scientific support of the Spanish Group for Paediatric and Neonatal CPR. The programme was divided into four phases: CPR training and preparation of instructors; training for instructors; supervised teaching; and independent teaching. During the first phase, 24 Honduran doctors from paediatric intensive care, paediatric emergency and anaesthesiology departments attended the paediatric CPR course and 16 of them the course for preparation as instructors. The Honduran Paediatric and Neonatal CPR Group was formed. In the second phase, workshops were given by Honduran instructors and four of them attended a CPR course in Spain as trainee instructors. In the third phase, a CPR course was given in Honduras by the Honduran instructors, supervised by the Spanish team. In the final phase of independent teaching, eight courses were given, providing 177 students with training in CPR. The training of independent paediatric CPR groups with the collaboration and scientific assessment of an expert group could be a suitable model on which to base paediatric CPR training in Latin American developing countries. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

  9. Paediatric Virology in the Hippocratic Corpus

    Science.gov (United States)

    Mammas, Ioannis N.; Spandidos, Demetrios A.

    2016-01-01

    Hippocrates (Island of Kos, 460 B.C.-Larissa, 370 B.C.) is the founder of the most famous Medical School of the classical antiquity. In acknowledgement of his pioneering contribution to the new scientific field of Paediatric Virology, this article provides a systematic analysis of the Hippocratic Corpus, with particular focus on viral infections predominating in neonates and children. A mumps epidemic, affecting the island of Thasos in the 5th century B.C., is described in detail. ‘Herpes’, a medical term derived from the ancient Greek word ‘ἕρπειν’, meaning ‘to creep’ or ‘crawl’, is used to describe the spreading of cutaneous lesions in both childhood and adulthood. Cases of children with exanthema ‘resembling mosquito bites’ are presented in reference to varicella or smallpox infection. A variety of upper and lower respiratory tract viral infections are described with impressive accuracy, including rhinitis, pharyngitis, tonsillitis, laryngitis, bronchiolitis and bronchitis. The ‘cough of Perinthos’ epidemic, an influenza-like outbreak in the 5th century B.C., is also recorded and several cases complicated with pneumonia or fatal outcomes are discussed. Hippocrates, moreover, describes conjunctivitis, otitis, lymphadenitis, meningoencephalitis, febrile convulsions, gastroenteritis, hepatitis, poliomyelitis and skin warts, along with proposed treatment directions. Almost 2,400 years later, Hippocrates' systematic approach and methodical innovations can inspire paediatric trainees and future Paediatric Virology subspecialists. PMID:27446241

  10. Ocular involvement in paediatric haemolytic uraemic syndrome.

    Science.gov (United States)

    Sturm, Veit; Menke, Marcel N; Landau, Klara; Laube, Guido F; Neuhaus, Thomas J

    2010-11-01

    The aim of this study was to estimate the frequency and severity of ocular involvement in paediatric patients with haemolytic uraemic syndrome (HUS). The study was designed as an institutional, retrospective, observational case series. Charts for all 87 paediatric patients with HUS treated at the University Children's Hospital Zurich between 1995 and 2007 were reviewed. Patients with ocular involvement were identified and clinical findings presented. Three of 69 examined patients with HUS showed ocular involvement. Ophthalmic findings in two children were consistent with bilateral Purtscher retinopathy, showing multiple haemorrhages, exudations and superficial retinal whitening. The third child presented with bilateral isolated central intraretinal haemorrhages as a milder form of ocular involvement. In one of the children with Purtscher retinopathy, laser photocoagulation was required for bilateral rubeosis irides and development of disc neovascularization. Longterm outcomes in the two severely affected children showed decreased visual acuity caused by partial atrophy of the optic nerves. In the milder case visual acuity was not impaired at any time. A minority of paediatric patients with HUS developed ocular involvement. Acute ocular findings varied in severity from isolated intraretinal haemorrhages to Purtscher-like retinopathy with retinal ischaemia. Longterm complications included the development of neovascularizations and consecutive optic nerve atrophy. Although ocular involvement in HUS seems to be rare, physicians should be aware of this complication because of its possible vision-endangering consequences. © 2009 The Authors. Journal compilation © 2009 Acta Ophthalmol.

  11. [The latest in paediatric resuscitation recommendations].

    Science.gov (United States)

    López-Herce, Jesús; Rodríguez, Antonio; Carrillo, Angel; de Lucas, Nieves; Calvo, Custodio; Civantos, Eva; Suárez, Eva; Pons, Sara; Manrique, Ignacio

    2017-04-01

    Cardiac arrest has a high mortality in children. To improve the performance of cardiopulmonary resuscitation, it is essential to disseminate the international recommendations and the training of health professionals and the general population in resuscitation. This article summarises the 2015 European Paediatric Cardiopulmonary Resuscitation recommendations, which are based on a review of the advances in cardiopulmonary resuscitation and consensus in the science and treatment by the International Council on Resuscitation. The Spanish Paediatric Cardiopulmonary Resuscitation recommendations, developed by the Spanish Group of Paediatric and Neonatal Resuscitation, are an adaptation of the European recommendations, and will be used for training health professionals and the general population in resuscitation. This article highlights the main changes from the previous 2010 recommendations on prevention of cardiac arrest, the diagnosis of cardiac arrest, basic life support, advanced life support and post-resuscitation care, as well as reviewing the algorithms of treatment of basic life support, obstruction of the airway and advanced life support. Copyright © 2016. Publicado por Elsevier España, S.L.U.

  12. Simultaneous bilateral elbow dislocation with bilateral medial epicondyle fractures in a 13-year-old female gymnast with hyperlaxity

    Science.gov (United States)

    Bauer, Stefan; Dunne, Ben; Whitewood, Colin

    2012-01-01

    Bilateral simultaneous elbow dislocations are extremely rare and have only been described in 12 cases. In the paediatric population unilateral elbow dislocations are rare with 3–6% of all elbow injuries and there are only few studies describing this injury exclusively in children. There is only one case report of a paediatric patient who sustained a simultaneous bilateral elbow dislocation with medial epicondyle fractures. We present a second paediatric case of simultaneous bilateral elbow dislocation with associated displaced bilateral medial epicondyle fractures in a gymnast with joint hyperlaxity (3 of 5 Wynne-Davies criteria) treated with closed reduction and short-term immobilisation (3 weeks). The patient returned to full trampoline gymnastics between 4 and 5 months postinjury and made an uneventful recovery. PMID:23234820

  13. Scotland's GP paediatric scholarship: an evaluation.

    Science.gov (United States)

    MacVicar, Ronald; Borland, Lyndsey; McHale, Sharon; Goh, Dayeel; Potter, Alex

    2018-05-01

    In a previous publication we described the implementation and early evaluation of general practice paediatric scholarships in Scotland. We suggested that it was too early to be able to determine whether this significant investment will produce a return for Scotland in terms of enhanced roles in providing, leading or developing children's services in primary care or at the primary care/secondary care interface. This paper presents the results of a survey of the impact of the scholarship for the first six cohorts of the scholarship (119 General Practitioners). The response rate was 76%. Of the 90 respondents, almost half (44) have developed roles or areas of special paediatric interest either within or out with the practice, or in three cases both within and out with the practice. A total of 37 (43%) of those that continue to work within general practice reported that they have developed areas of special interest of benefit to the practice. Qualitative analysis of free text questions suggested that scholars had benefited from their experience in terms of increased confidence in dealing with child health problems, developing links with secondary care colleagues, and personal gain with respect to role development. What is already known in this area: Changes in GP Training have been suggested in order to provide a workforce that can meet the needs of infants, children and young people. Studies have shown a positive impact of paediatric trainees and GP trainees learning together. Little attention has however been given to the potential to support trained GPs to develop their expertise in child health. What this work adds: Early evaluation of the Scottish Paediatric Scholarship suggested a high degree of satisfaction. This more robust evaluation suggests that almost half (44/90 respondents) have developed roles or areas of special paediatric interest either within or out with the practice, or in three cases both within and out with the practice. Suggestions for future

  14. Canine total knee replacement performed due to osteoarthritis subsequent to distal femur fracture osteosynthesis: two-year objective outcome.

    Science.gov (United States)

    Eskelinen, E V; Liska, W D; Hyytiäinen, H K; Hielm-Björkman, A

    2012-01-01

    A 27-kg German Shorthaired Pointer was referred for evaluation due to the complaint of left pelvic limb lameness and signs of pain in the left stifle joint. Radiographs revealed signs of a healed supracondylar femoral fracture that had been previously repaired at another hospital with an intramedullary pin and two cross pins. In addition, there were signs of severe osteoarthritis (OA). The OA had been managed medically with administration of carprofen and nutraceuticals for nine months without any improvement. Left total knee replacement (TKR) surgery was performed to alleviate signs of pain. The patient was assessed preoperatively and at six months, one year, and two years after surgery using radiology, force platform analysis of gait, thigh circumference measures, goniometry, and lameness evaluation. Following surgery, the dog resumed normal activity without any signs of pain and a good quality of life at 3.5 months. Force plate analysis found that peak vertical force on the TKR limb was 85.7% of the normal contralateral limb after two years. Total knee replacement was a successful treatment to manage knee OA associated with a healed distal femoral fracture and internal fixation in this dog.

  15. Unusual proximal femur fracture in children treated with PHILOS plate and review of literature

    Directory of Open Access Journals (Sweden)

    Mukesh Kumar

    2017-01-01

    Full Text Available Fractures of the hip are uncommon in children with incidence is less than 1% in all paediatrics fracture. It requires careful attention because of the incidence of complications is high. There is no consensus over ideal treatment of each group, but there are different options for each group has been described in literature, we report a case of unusual proximal femur fracture in ten-year-old girl which is not described in literature in best of our knowledge. A 10 years old girl was brought to us with pain in right hip joint and inability to bear weight on right lower limb after road traffic accident (child was hit by a car while walking on the road. Evaluated and found to have fracture of proximal femur. fracture was fixed with long PHILOS plate, which united in eight weeks duration, implant was removed at 10 month. At present after 14 months, she is able to perform her routine activities comfortably. and her Harris hip score is 95. We propose to add this type of fracture as 5th type of Delbet's classification as the fracture pattern in my patient was not fitting in any group of Delbet's classification and it belongs to proximal femur group and anatomically this fracture pattern was next to type IV fracture. Uncommon fracture of hip in children can be expected, this type of fracture can be added as 5th type in Delbet's classification. Long term outcome and ideal treatment yet to be described.

  16. Hip fracture - discharge

    Science.gov (United States)

    ... neck fracture repair - discharge; Trochanteric fracture repair - discharge; Hip pinning surgery - discharge ... in the hospital for surgery to repair a hip fracture, a break in the upper part of ...

  17. HIV infection, tuberculosis and workload in a general paediatric ward

    African Journals Online (AJOL)

    South African Journal of Child Health ... To describe the impact of HIV infection and tuberculosis on the workload of a general paediatric ward at Red Cross War Memorial Children's Hospital in 2007. Methods. Prospective descriptive surveillance of the patient composition of a general paediatric ward over a 1-year period.

  18. The paediatric acute scrotum: are we still managing correctly?

    African Journals Online (AJOL)

    Objective The objective of this study was to investigate current investigation and management practice in a general district hospital in the UK of the paediatric acute scrotum. Summary background Diagnosis and management of the paediatric acute scrotum remains an elusive and often challenging area of urology.

  19. Caring for paediatric patient as to broaden radiography spectrum

    International Nuclear Information System (INIS)

    Atiti, J.S.M.

    2006-01-01

    The paediatric patient is a special group of patients in the hospital set up. thus their special needs contribute to about 75% of quality imaging services offered. Age, Psychological aspects, parents participation, departmental atmosphere and environmental make them special. this presentation aims at installing into Imaging Technologies a sense of Responsibility for purpose of improving the resultant quality of Imaging services offered to paediatrics

  20. The practice of paediatric cardiology in Nigeria: A Review | Chinawa ...

    African Journals Online (AJOL)

    Background: The practice of Paediatric cardiology in Nigeria is at its early phase and it is being choked in an environment overwhelmed with economic, ethnic and political issues. Paediatric cardiology covers a broad area of medicine. This includes diagnosis, medical treatment, interventional cardiology, prenatal diagnosis ...

  1. Use of Zoledronic Acid in Paediatric Craniofacial Fibrous Dysplasia

    Directory of Open Access Journals (Sweden)

    Chiara Di Pede

    2016-01-01

    Full Text Available We describe a case of a paediatric patient affected by mandibular fibrous dysplasia (FD with severe and chronic pain who was successfully treated with zoledronic acid (ZOL: a third-generation bisphosphonate. Further research is needed to assess its safety and efficacy as a treatment option for FD in the paediatric population.

  2. The undergraduate paediatric surgery curriculum in Nigeria – how ...

    African Journals Online (AJOL)

    This study aimed to: (i) identify main objectives of paediatric surgery at he undergraduate level; (ii) establish students' knowledge with regard to these objectives; (iii) evaluate the input of both specialists and non-specialists to these objectives; and (iv) examine the status of undergraduate paediatric surgery instruction in our ...

  3. A review of paediatric anaesthetic-related mortality, serious adverse ...

    African Journals Online (AJOL)

    Keywords: mortality, outcomes, paediatric anaesthesia, perioperative, risks. Introduction ... informed decisions on patient care.2,17,18 ... use of a case mix and institutional audit with a small sample size.2,27,28, ..... Anesthesia safety: model or myth? .... Thomas J. Paediatric anaesthesia: a risky business?: guest editorial. S.

  4. Pattern of Paediatric Trauma in North Western Nigeria | Mungadi ...

    African Journals Online (AJOL)

    Socio-economic emancipation, intra-city traffic considerations, abrogation of child labour and provision of adequate water supply should reduce these accidents. Trauma prevention and care programme in developing countries should always address paediatric injuries. KEY Words: Paediatric, Trauma, North Western, ...

  5. Impact of the learning environment on career intentions of paediatric ...

    African Journals Online (AJOL)

    training on career intentions, specifically in terms of paediatrics, in a ... SA paediatric interns work in an environment with a high ... already challenging learning environment (LE) for interns. ... doctors during internship may influence career trajectories in a direction that is discordant with .... Cronbach's alpha for the teaching,.

  6. Weight-band dosing tables: simplifying paediatric art | Nuttall ...

    African Journals Online (AJOL)

    One of the obstacles to scaling up paediatric antiretroviral therapy (ART) coverage in resource-limited settings is the relative complexity of paediatric dosing. There is a need to simplify ART in order to facilitate treatment initiation and ongoing management of infants and children by health care providers, as well as to support ...

  7. Exciting times: Towards a totally minimally invasive paediatric urology service

    OpenAIRE

    Lazarus, John

    2011-01-01

    Following on from the first paediatric laparoscopic nephrectomy in 1992, the growth of minimally invasive ablative and reconstructive procedures in paediatric urology has been dramatic. This article reviews the literature related to laparoscopic dismembered pyeloplasty, optimising posterior urethral valve ablation and intravesical laparoscopic ureteric reimplantation.

  8. An audit of paediatric intussusception radiological reduction at the ...

    African Journals Online (AJOL)

    Methods. This retrospective analytic cohort study assessed data from the records of all paediatric patients with the diagnosis of idiopathic intussusception discharged from the Department of Paediatric Surgery between 1 January 2003 and 30 September 2011. Results. Thirty-five children with intussusception were identified.

  9. Future career intentions of higher specialist trainees in general Paediatrics.

    Science.gov (United States)

    Butler, Grainne; Breatnach, Colm; Harty, Sinead; Gavin, Patrick; O'Donnell, Colm; O'Grady, Michael J

    2018-03-27

    A survey of paediatric higher specialist trainees was carried out in 2002 assessing career intentions and perception of training. Fourteen years later, with increased numbers of trainees and a national model of care and a tertiary paediatric hospital on the horizon, we re-evaluated the career intentions of the current trainee workforce. To assess the career intentions of the current paediatric higher specialist trainees. A 28-item questionnaire was developed based on a previously validated instrument and distributed online using the Royal College of Physicians of Ireland trainee database. We distributed the questionnaire to 118 eligible trainees and received responses from 92 (78%). Seventy-nine (86%) respondents desire a consultant post in Ireland. Seventy-five (82%) indicated that their preferred consultant post location was in a tertiary paediatric centre. Sixty-two trainees (67%) intend to become subspecialists with 25 (27%) planning a career in general paediatrics. This contrasts with the 2002 survey when 76% wished to work in urban centres and 61% of trainees planned a career in general paediatrics. There appears to be a mismatch between the career goals of the future paediatric consultant workforce and the requirements for staffing paediatric units nationally. This has the potential to complicate the proposed expansion of general paediatricians in regional centres and result in a significant proportion of current trainees failing to secure a post in their desired location.

  10. The paediatric surgeon and his working conditions in Francophone ...

    African Journals Online (AJOL)

    Background: This study described the current conditions of work of paediatric surgeons in Francophone sub-Saharan Africa (FSSA) and set the debate at the level of the humanist thinking in medicine. Patients and Methods: This was a multicentre study from 1st May to 30th October 2008. The African Society of paediatric ...

  11. Monitoring of rotavirus infection in a paediatric hospital by RNA ...

    African Journals Online (AJOL)

    During the spring of 1987 and the autumn of 1988, stool specimens were collected from infants and young children in the paediatric unit at H. F. Verwoerd Hospital, Pretoria, and examined for the presence of rotaviruses to assess the potential for hospital-acquired infection in the paediatric wards. Stool samples were also ...

  12. SAMJ Monitoring of rotavirus infection in a paediatric hospital by ...

    African Journals Online (AJOL)

    During the spring of 1987 and the autumn of 1988, stool specimens were collected from infants and young children in the paediatric unit at H. F. Verwoerd Hospital, Pretoria, and examined for the presence of rotaviruses to assess the potential for hospital-acquired infection in the paediatric wards. Stool samples were also ...

  13. Paediatric fever management: continuing education for clinical nurses.

    Science.gov (United States)

    Walsh, Anne M; Edwards, Helen E; Courtney, Mary D; Wilson, Jenny E; Monaghan, Sarah J

    2006-01-01

    This study examined the influence of level of practice, additional paediatric education and length of paediatric and current experience on nurses' knowledge of and beliefs about fever and fever management. Fifty-one nurses from medical wards in an Australian metropolitan paediatric hospital completed a self-report descriptive survey. Knowledge of fever management was mediocre (Mean 12.4, SD 2.18 on 20 items). Nurses practicing at a higher level and those with between one and four years paediatric or current experience were more knowledgeable than novices or more experienced nurses. Negative beliefs that would impact nursing practice were identified. Interestingly, beliefs about fever, antipyretic use in fever management and febrile seizures were similar; they were not influenced by nurses' knowledge, experience, education or level of practice. Paediatric nurses are not expert fever managers. Knowledge deficits and negative attitudes influence their practice irrespective of additional paediatric education, paediatric or current experience or level of practice. Continuing education is therefore needed for all paediatric nurses to ensure the latest clear evidence available in the literature for best practice in fever management is applied.

  14. A practical approach to anaesthesia for paediatric liver transplantation

    African Journals Online (AJOL)

    A practical approach to anaesthesia for paediatric liver transplantation. Jenny Thomas, M McCulloch, W Spearman, T Butt, A Numanoglu ... In more recent years, the use of reduced size and living related organs has increased the donor pool for infants and children. Paediatric liver transplantation in South Africa, up until the ...

  15. A comparison of paediatric dentists' and general dental practitioners' care patterns in paediatric dental care

    NARCIS (Netherlands)

    Schorer-Jensma, M.A.; Veerkamp, J.S.J.

    2010-01-01

    AIM: The aim of this study was to compare the care patterns of paediatric dentists and general dentists in the dental treatment of children in the Netherlands. STUDY DESIGN AND METHODS: A case control study was completed based on the financial records of one of the largest Dutch health insurance

  16. Flexible intramedullary nailing for femoral diaphyseal fractures in children

    Directory of Open Access Journals (Sweden)

    Rojan Tamrakar

    2017-12-01

    Full Text Available Background & Objectives: Although various treatment options are available for the treatment of femoral diaphyesal fractures in children, the titanium flexible nailing has gained popularity because it is safe, easy procedure with rapid recovery and high success rate. The aim of this study was to evaluate the outcome of titanium elastic nails in treating paediatric femoral diaphyesal fractures at Patan Hospital.Materials & Methods: There were 35 cases which were all fixed with titanium flexible intramedullary nail under image intensifier at the Patan hospital from January 2013 and December 2015. Patients were evaluated in follow-ups to observe the alignment of fracture, infection, delayed union, nonunion, limb length discrepancy, implant failure, range of movement of hip and knee joints, and time to unite the fracture. The final results were evaluated using criteria of titanium elastic nail (TEN outcome score described by Flynn et al.Results: The mean age of the patients was 8.51 years. Among 35 patients (22 boys and 13 girls, there were 19 mid-shaft fractures, nine proximal third fractures and seven distal third fractures. Fracture patterns were transverse (22, oblique (10, spiral (2, and comminuted (2. The mean time for fracture union was 8.17 weeks radiologically whereas 9.83 weeks clinically. According to TEN outcome score, excellent and good results were in 28 cases (80% and seven cases (20% respectively.Conclusion: Flexible titanium nailing is a safe and satisfactory treatment for diaphyseal femoral fractures in children, because it provides rapid recovery, short rehabilitation and immobilization as well as very high union rate with few complications.

  17. Pancreaticoduodenectomy in children: optimising outcome of uncommon paediatric procedures.

    LENUS (Irish Health Repository)

    Yeap, B H

    2012-02-01

    Contemporary surgical practice is increasingly dominated by subspecialisation in response to improved outcome from high volume centres, though uncertainties persist for uncommon paediatric procedures. Three paediatric pancreaticoduodenectomies performed at Our Lady\\'s Children\\'s Hospital, Dublin, over a period of 9 years were evaluated to substantiate their continuing performance by paediatric rather than adult pancreatic surgeons. With ages ranging from 18 months to 8 years old, the mean operating time was 263 minutes, while the average hospital stay was 12 days. There was no perioperative mortality, although complication rate was 100%. Re-operation was required in 33%. The long term outcome of this small paediatric cohort was comparable to adult series despite the low patient accrual, underscoring the advantages of a multidisciplinary approach afforded by tertiary paediatric institutions for intricate yet infrequent operations in children.

  18. Proximal femoral fractures.

    Science.gov (United States)

    Webb, Lawrence X

    2002-01-01

    Fractures of the proximal femur include fractures of the head, neck, intertrochanteric, and subtrochanteric regions. Head fractures commonly accompany dislocations. Neck fractures and intertrochanteric fractures occur with greatest frequency in elderly patients with a low bone mineral density and are produced by low-energy mechanisms. Subtrochanteric fractures occur in a predominantly strong cortical osseous region which is exposed to large compressive stresses. Implants used to address these fractures must be able to accommodate significant loads while the fractures consolidate. Complications secondary to these injuries produce significant morbidity and include infection, nonunion, malunion, decubitus ulcers, fat emboli, deep venous thrombosis, pulmonary embolus, pneumonia, myocardial infarction, stroke, and death.

  19. Evaluating paediatric brain injury services in NSW.

    Science.gov (United States)

    Badge, H; Hancock, J; Waugh, M-C

    2010-01-01

    Rehabilitation professionals strive to provide high-quality evidence-based services for children. Developing systems to measure and monitor the benefits of our services, and health outcomes for children is complex and challenging. The Community Outcome Project aims to introduce systematic outcome measurement across the network of paediatric community-based brain injury services within the New South Wales Brain Injury Rehabilitation Program (BIRP) to support clinical practice and service evaluation. A literature review informed the development of the evaluative framework and identified available paediatric outcome measures which may be appropriate. Extensive consultation with clinicians supported project planning and identified clinical priorities that the outcome measures needed to capture. Outcome measures were shortlisted by matching them to identified clinical priorities, and then trialled in clinical practice. Qualitative feedback regarding clinical utility and feasibility was obtained from clinical staff. The process has utilized change management strategies to ensure the success of the project and keep staff engaged. The process identified the three main clinical priorities for outcome measurement - family functioning, school performance and participation. Three outcome measures were chosen for the pilot project that is currently underway. They are Family Burden of Injury Interview, Academic Competence and Evaluation Scales and Child and Adolescent Scale of Participation. Plans for analyses of outcome data within the paediatric BIRP services are discussed. Extensive preparation is required to optimize staff engagement in a project that systematically introduces outcome measures that are useful to clinicians, clients and service providers. Managing the change required is a key focus of the project. Benefits and costs to clinicians and services will be discussed.

  20. Voluntary Informed Consent in Paediatric Oncology Research.

    Science.gov (United States)

    Dekking, Sara A S; Van Der Graaf, Rieke; Van Delden, Johannes J M

    2016-07-01

    In paediatric oncology, research and treatments are often closely combined, which may compromise voluntary informed consent of parents. We identified two key scenarios in which voluntary informed consent for paediatric oncology studies is potentially compromised due to the intertwinement of research and care. The first scenario is inclusion by the treating paediatric oncologist, the second scenario concerns treatments confined to the research context. In this article we examine whether voluntary informed consent of parents for research is compromised in these two scenarios, and if so whether this is also morally problematic. For this, we employ the account of voluntary consent from Nelson and colleagues, who assert that voluntary consent requires substantial freedom from controlling influences. We argue that, in the absence of persuasion or manipulation, inclusion by the treating physician does not compromise voluntariness. However, it may function as a risk factor for controlling influence as it narrows the scope within which parents make decisions. Furthermore, physician appeal to reciprocity is not controlling as it constitutes persuasion. In addition, framing information is a form of informational manipulation and constitutes a controlling influence. In the second scenario, treatments confined to the research context qualify as controlling if the available options are restricted through manipulation of options. Although none of the influences is morally problematic in itself, a combination of influences may create morally problematic instances of involuntary informed consent. Therefore, safeguards should be implemented to establish an optimal environment for parents to provide voluntary informed consent in an integrated research-care context. © 2015 John Wiley & Sons Ltd.

  1. Texting preferences in a Paediatric residency.

    Science.gov (United States)

    Draper, Lauren; Kuklinski, Cadence; Ladley, Amy; Adamson, Greg; Broom, Matthew

    2017-12-01

    Text messaging is ubiquitous among residents, but remains an underused educational tool. Though feasibility has been demonstrated, evidence of its ability to improve standardised test scores and provide insight on resident texting preferences is lacking. The authors set out to evaluate: (1) satisfaction with a hybrid question-and-answer (Q&A) texting format; and (2) pre-/post-paediatric in-training exam (ITE) performance. A prospective study with paediatrics and internal medicine-paediatrics residents. Residents were divided into subgroups: adolescent medicine (AM) and developmental medicine (DM). Messages were derived from ITE questions and sent Monday-Friday with a 20 per cent variance in messages specific to the sub-group. Residents completed surveys gauging perceptions of the programme, and pre- and post-programme ITE scores were analysed. Forty-one residents enrolled and 32 (78%) completed a post-programme survey. Of those, 21 (66%) preferred a Q&A format with an immediate text response versus information-only texts. The percentage change in ITE scores between 2013 and 2014 was significant. Comparing subgroups, there was no significant difference between the percentage change in ITE scores. Neither group performed significantly better on either the adolescent or developmental sections of the ITE. Text messaging… remains an underused educational tool CONCLUSIONS: Overall, participants improved their ITE scores, but no improvement was seen in the targeted subgroups on the exam. Although Q&A texts are preferred by residents, further assessment is required to assess the effect on educational outcomes. © 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

  2. High Flow Nasal Cannula Oxygen Therapy can be used safely in the general paediatric ward using Paediatric Early Warning Scores

    NARCIS (Netherlands)

    Morsing, IE; Tinnevelt, Marcel; Jansen, Nicolaas J.G.; Koomen, E

    2015-01-01

    High Flow Nasal Cannula oxygen therapy (HFNC) is nowadays widely used at paediatric intensive care units (PICU) to provide a safe and comfortable (warm and humidified) oxygen delivery in children with respiratory distress. At general paediatric wards HFNC is hardly used because intensive observation

  3. MIH: epidemiologic clinic study in paediatric patient.

    Science.gov (United States)

    Condò, R; Perugia, C; Maturo, P; Docimo, R

    2012-04-01

    The Molar Incisor Hypomineralization (MIH) is a qualitative and quantitative defect of the enamel structure of the first permanent molars, which may vary from 1 to 4 with involvement of maxillary and jaw permanent incisors. AIM.: Aim of this study is that to evaluate, among 1500 paediatric patients chosen at random aged between 0 and 14 years, afferent by the Paediatric Dentistry of the Azienda Ospedialiera Policlinico Tor Vergata of Rome from 1996 to 2011, the incidents and the prevalence of the MIH distribution, and furthermore to ascertain the possible relationship with the data described in the literature. RESULTS AND DISCUSSION.: From the sample of 1500 paediatric patients, the number of those affections from MIH has turned out to be pairs to 110 (7.3%) aged between 4 and 15 years, and an average age equal to 9.7. The incidence of the hypoplastic defects is greater in the elements of the permanents series in which the functional class mainly interested is that of the first molars, with a percentage of 39.8%. Regarding the elements of the deciduous series affections from hypoplasia, they turn out to be in all in number of 20 represented in 80% of the cases from the seconds molars while in the remaining 20% of the cases the items involved are the central incisors. About the percentage of elements involved in the MIH: the molars, involved with a frequency of 56%, turn out to be more hit regarding incisors (44%). As reported in the literature, it can be asserted that the MIH can hit in equal measure both the male sex that feminine one. CONCLUSIONS.: MIH represents a condition quite frequent in the paediatric population. In managing this anomaly takes an essential role in the early diagnosis and in the differential one. The study done underlined the importance of a correct application of the therapeutic protocol which, starting from a careful diagnosis and articulating themselves in the execution of preventive treatments and in severe cases restorative and

  4. Summarized institutional experience of paediatric airway surgery†.

    Science.gov (United States)

    Hoetzenecker, Konrad; Schweiger, Thomas; Schwarz, Stefan; Roesner, Imme; Leonhard, Matthias; Denk-Linnert, Doris-Maria; Schneider-Stickler, Berit; Bigenzahn, Wolfgang; Klepetko, Walter

    2016-04-01

    The management of paediatric airway stenosis is complex, and requires a dedicated team, consisting of thoracic surgeons, phoniatricians, logopaedics, paediatricians and anaesthetists. The majority of paediatric laryngotracheal stenosis is a sequela of prematurity and prolonged post-partal intubation/tracheostomy. Surgical correction is often difficult due to a frequent combination of glottic and subglottic defects. In 2012, the Laryngotracheal Program Vienna was launched. Since then, 18 paediatric patients were surgically treated for (laryngo-)tracheal problems. The median age of our patients was 26 months (range 2-180 months). Laryngotracheal stenosis extending up to the level of the vocal cords was evident in 9 patients. Three children were diagnosed with an isolated subglottic, and four with a short-segment tracheal stenosis or malacia. Two patients had a long-segment congenital malformation together with vascular ring anomalies. Five children were pretreated by rigid endoscopy before surgical correction, 12 of our 18 patients had a tracheostomy, 3 children were intubated at the time of operation. Different techniques of corrections were applied: laryngotracheal reconstruction (n = 4), extended partial cricotracheal resection (n = 4), cricotracheal resection with or without anterior split or dorsal mucosal flap (n = 4), slide tracheoplasty (n = 2), tracheal resection (n = 4). In 8 patients, a rib cartilage interposition was necessary in order to obtain a sufficient lumen enlargement and in 7 of these patients, an LT-Mold was placed to stabilize the reconstruction. We lost 2 patients, who were referred to our institution after failure of multiple preceding interventions, 2 and 3 months after the operation. Twelve patients are currently in an excellent condition, one is in an acceptable condition without a need for an intervention. Two patients required an endoscopic reintervention 18 and 33 months after the operation, 1 child is currently still cannulated

  5. The Investigation of Proptosis in Paediatric Practice

    Directory of Open Access Journals (Sweden)

    Ms Sayantani Ghosh

    2009-08-01

    Full Text Available A retrospective review of 65 cases of paediatric proptosispresenting to a rural teaching hospital in India, from February2006 to June 2008. There were 17 cases with orbital cellulitisand 15 with retinoblastoma. We report the history, clinicalexamination, radiological findings and diagnosis. Most caseshad a characteristic history and pathognomonic eye signs.Computer Tomography (CT correlated with histopathology inmost cases. CT is widely available, even within a remotesetting, and is a convenient investigation. Thus, a detailedhistory, clinical examination and CT scan were the mostfruitful approach to the diagnosis of childhood proptosis inthis series.

  6. Myroides Species in a Paediatric Burn Patient

    Directory of Open Access Journals (Sweden)

    Sevda Soydan

    2017-11-01

    Full Text Available Members of the genus Myroides are non-motile, Gram negative bacteria that are mostly found in environmental sources such as soil and water. They are not a part of human flora. For a long time they were evaluated as low grade opportunistic pathogens causing infections in immunocompromised patients whereas a few life-threatening infections were reported in immunocompetent individuals due to Myroides species. The child having a 64% of total body surface area burn was admitted to the burn unit. Myroides spp. was isolated first in urine culture then in blood culture. This is the first time Myroides spp. is reported in a paediatric patient with serious burn.

  7. Acceptability and practicality of a Spanish translation of paediatric Gait Arms Legs and Spine (pGALS) in Peruvian children.

    Science.gov (United States)

    Abernethy, Katrina; Jandial, Sharmila; Hill, Lucy; Sánchez, Ernesto Salazar; Foster, Helen

    2014-01-01

    The paediatric Gait, Arms, Legs and Spine (pGALS) musculoskeletal examination tool is validated for use in school-aged English Speaking children and shown to be practical and effective in acute paediatric practice in the UK and Malawi. Our aim was to assess the acceptability and practicality of a Spanish translation of pGALS in an acute paediatric setting in Peru. Fifty-three school-aged children presenting to Hospital Regional de Loreto, Peru were recruited to undergo a pGALS examination using a Spanish translation of the instructions. The pGALS examination was completed in 92.5% (49/53), with the time taken (median 4.42 minutes) being acceptable to most parents (98.1%, 52/53). Most children (88.7%, 47/53), found the pGALS examination caused 'little' or 'no additional discomfort'. Using pGALS, significant findings were observed in 18/53 (34%) children; these related to fractures (4/18), hypermobility (4/18), infectious causes (5/18) and soft tissue trauma (5/18). Using this Spanish translation, pGALS assessment was practical, acceptable and effective in detecting musculoskeletal changes in many children.

  8. Routine perinatal and paediatric post-mortem radiography: detection rates and implications for practice

    Energy Technology Data Exchange (ETDEWEB)

    Arthurs, Owen J. [NHS Foundation Trust, Department of Radiology Great Ormond Street Hospital for Children, London (United Kingdom); University College London, Institute of Child Health, London (United Kingdom); Calder, Alistair D. [NHS Foundation Trust, Department of Radiology Great Ormond Street Hospital for Children, London (United Kingdom); Kiho, Liina [Camelia Botnar Laboratories Great Ormond Street Hospital for Children, Department of Paediatric Pathology, London (United Kingdom); Taylor, Andrew M. [Great Ormond Street Hospital for Children, Cardiorespiratory Unit, London (United Kingdom); UCL Institute of Cardiovascular Science, London (United Kingdom); University College London, Institute of Child Health, London (United Kingdom); Sebire, Neil J. [Camelia Botnar Laboratories Great Ormond Street Hospital for Children, Department of Paediatric Pathology, London (United Kingdom); University College London, Institute of Child Health, London (United Kingdom)

    2014-03-15

    Routine perinatal and paediatric post-mortem plain radiography allows for the diagnosis and assessment of skeletal dysplasias, fractures and other bony abnormalities. The aim of this study was to review the diagnostic yield of this practice. We identified 1,027 cases performed in a single institution over a 21/2-year period, including babygrams (whole-body examinations) and full skeletal surveys. Images were reported prior to autopsy in all cases. Radiology findings were cross-referenced with the autopsy findings using an autopsy database. We scored each case from 0 to 4 according to the level of diagnostic usefulness. The overall abnormality rate was 126/1,027 (12.3%). There was a significantly higher rate of abnormality when a skeletal survey was performed (18%) rather than a babygram (10%; P < 0.01); 90% (665/739) of babygrams were normal. Of the 74 abnormal babygrams, we found 33 incidental non-contributory cases, 19 contributory, 20 diagnostic, and 2 false-positive cases. There were only 2 cases out of 739 (0.27%) in whom routine post-mortem imaging identified potentially significant abnormalities that would not have been detected if only selected imaging had been performed. A policy of performing selected, rather than routine, foetal post-mortem radiography could result in a significant cost saving. Routine post-mortem paediatric radiography in foetuses and neonates is neither diagnostically useful nor cost-effective. A more evidence-based, selective protocol should yield significant cost savings. (orig.)

  9. Routine perinatal and paediatric post-mortem radiography: detection rates and implications for practice

    International Nuclear Information System (INIS)

    Arthurs, Owen J.; Calder, Alistair D.; Kiho, Liina; Taylor, Andrew M.; Sebire, Neil J.

    2014-01-01

    Routine perinatal and paediatric post-mortem plain radiography allows for the diagnosis and assessment of skeletal dysplasias, fractures and other bony abnormalities. The aim of this study was to review the diagnostic yield of this practice. We identified 1,027 cases performed in a single institution over a 21/2-year period, including babygrams (whole-body examinations) and full skeletal surveys. Images were reported prior to autopsy in all cases. Radiology findings were cross-referenced with the autopsy findings using an autopsy database. We scored each case from 0 to 4 according to the level of diagnostic usefulness. The overall abnormality rate was 126/1,027 (12.3%). There was a significantly higher rate of abnormality when a skeletal survey was performed (18%) rather than a babygram (10%; P < 0.01); 90% (665/739) of babygrams were normal. Of the 74 abnormal babygrams, we found 33 incidental non-contributory cases, 19 contributory, 20 diagnostic, and 2 false-positive cases. There were only 2 cases out of 739 (0.27%) in whom routine post-mortem imaging identified potentially significant abnormalities that would not have been detected if only selected imaging had been performed. A policy of performing selected, rather than routine, foetal post-mortem radiography could result in a significant cost saving. Routine post-mortem paediatric radiography in foetuses and neonates is neither diagnostically useful nor cost-effective. A more evidence-based, selective protocol should yield significant cost savings. (orig.)

  10. EVALUATION OF FUNCTIONAL OUTCOME AFTER OPEN REDUCTION AND INTERNAL FIXATION OF DISTAL FEMUR FRACTURES BY LOCKING COMPRESSION PLATE

    Directory of Open Access Journals (Sweden)

    L. Lokanadha Rao

    2016-09-01

    Full Text Available BACKGROUND In the supra and intercondylar fractures of femur particularly with intra articular extension, patient may develop stiffness of knee, shortening, rotational deformities, internal derangement of knee with instability, varus and valgus deformities which affect patient’s routine lifestyle. If these cases were treated with locking compression plate, the results obtained were successful, superior, timesaving providing early ambulation and least disability improving the functional outcome. MATERIALS AND METHODS This is a prospective interventional study. This study includes 25 supracondylar and intercondylar fractures of femur (both Muller’s Type ‘A’, Type B and Type ‘C’ fractures treated with open reduction and internal fixation by Locking Compression Plate in the Department of Orthopaedics, King George Hospital, Visakhapatnam from September 2013 to September 2015. There are 16 males and 9 females with age ranging from 20 to 80 years with an average of 44.6 years. Average age for males is 28.9 years and average age for females is 25 years. 18 fractures were due to road traffic accidents and 6 cases are due to fall from significant heights, 1 case due to simple fall from standing (osteoporosis. 15 cases were in right femur (60% and 10 cases were in left femur (40%. RESULTS 25 cases were included in the study. There is an increase in the rate of union, decreased time taken for union, increased knee range of motion, decreased time for weight-bearing, postoperative complications and duration for hospital stay. CONCLUSION LCP proved to be a good implant which could take the challenges like poor bone stock, severe comminution both metaphyseal and articular and prove successful. The locking head screws distally have prevented varus collapse, even in cases of osteoporosis. The Condylar LCP can be used in either an open or a minimally invasive manner.

  11. A paediatric X-ray exposure chart

    Energy Technology Data Exchange (ETDEWEB)

    Knight, Stephen P, E-mail: stephen.knight@health.qld.gov.au [Department of Medical Imaging, Royal Children' s Hospital, Brisbane, Queensland (Australia)

    2014-09-15

    The aim of this review was to develop a radiographic optimisation strategy to make use of digital radiography (DR) and needle phosphor computerised radiography (CR) detectors, in order to lower radiation dose and improve image quality for paediatrics. This review was based on evidence-based practice, of which a component was a review of the relevant literature. The resulting exposure chart was developed with two distinct groups of exposure optimisation strategies – body exposures (for head, trunk, humerus, femur) and distal extremity exposures (elbow to finger, knee to toe). Exposure variables manipulated included kilovoltage peak (kVp), target detector exposure and milli-ampere-seconds (mAs), automatic exposure control (AEC), additional beam filtration, and use of antiscatter grid. Mean dose area product (DAP) reductions of up to 83% for anterior–posterior (AP)/posterior–anterior (PA) abdomen projections were recorded postoptimisation due to manipulation of multiple-exposure variables. For body exposures, the target EI and detector exposure, and thus the required mAs were typically 20% less postoptimisation. Image quality for some distal extremity exposures was improved by lowering kVp and increasing mAs around constant entrance skin dose. It is recommended that purchasing digital X-ray equipment with high detective quantum efficiency detectors, and then optimising the exposure chart for use with these detectors is of high importance for sites performing paediatric imaging. Multiple-exposure variables may need to be manipulated to achieve optimal outcomes.

  12. The neurophysiology of paediatric movement disorders.

    Science.gov (United States)

    McClelland, Verity M

    2017-12-01

    To demonstrate how neurophysiological tools have advanced our understanding of the pathophysiology of paediatric movement disorders, and of neuroplasticity in the developing brain. Delineation of corticospinal tract connectivity using transcranial magnetic stimulation (TMS) is being investigated as a potential biomarker for response to therapy. TMS measures of cortical excitability and neuroplasticity are also being used to investigate the effects of therapy, demonstrating neuroplastic changes that relate to functional improvements. Analyses of evoked potentials and event-related changes in the electroencephalogaphy spectral activity provide growing evidence for the important role of aberrant sensory processing in the pathophysiology of many different movement disorders. Neurophysiological findings demonstrate that children with clinically similar phenotypes may have differing underlying pathophysiology, which in turn may explain differential response to therapy. Neurophysiological parameters can act as biomarkers, providing a means to stratify individuals, and are well suited to provide biofeedback. They therefore have enormous potential to facilitate improvements to therapy. Although currently a small field, the role of neurophysiology in paediatric movement disorders is poised to expand, both fuelled by and contributing to the rapidly growing fields of neuro-rehabilitation and neuromodulation and the move towards a more individualized therapeutic approach.

  13. MR imaging of paediatric uterovaginal anomalies

    International Nuclear Information System (INIS)

    Lang, I.M.; Babyn, P.; Oliver, G.D.

    1999-01-01

    Background. Transabdominal ultrasound (US) has not proved completely reliable in Muellerian duct anomalies. One study has shown it useful in obstructed uterovaginal anomalies. We are unaware of a study that has used endovaginal ultrasound in children to investigate uterovaginal anomalies. Magnetic resonance imaging (MRI) is now gaining wide acceptance in imaging congenital abnormalities of the genital tract. Objective. To identify the problems and potential pitfalls of using MRI to evaluate the female genital tract in paediatric patients. Materials and methods. A retrospective review of the MRI scans of 19 patients, aged 3 months to 19 years (mean 14 years), with uterovaginal anomalies. Results. The uterovaginal anomalies were categorised into three groups: (1) congenital absence of the Muellerian ducts, or the Mayer-Rokitansky-Kuster-Hauser syndrome (n = 7), (2) disorders of vertical fusion (n = 2) and (3) disorders of lateral fusion (n = 10). Conclusions. MRI is a reliable method for evaluating paediatric uterovaginal anomalies, but should be analysed in conjunction with other imaging modalities (US and genitography). Previous surgery makes interpretation more difficult and, if possible, MRI should be carried out prior to any surgery. An accurate MRI examination can be extremely helpful prior to surgery and it is important for the radiologist to have knowledge of how these complex anomalies are managed and what pitfalls to avoid. (orig.)

  14. Mechanisms, patterns and outcomes of paediatric polytrauma in a UK major trauma centre.

    Science.gov (United States)

    Naqvi, G; Johansson, G; Yip, G; Rehm, A; Carrothers, A; Stöhr, K

    2017-01-01

    Introduction Paediatric trauma is a significant burden to healthcare worldwide and accounts for a large proportion of deaths in the UK. Methods This retrospective study examined the epidemiological data from a major trauma centre in the UK between January 2012 and December 2014, reviewing all cases of moderate to severe trauma in children. Patients were included if aged ≤16 years and if they had an abbreviated injury scale score of ≥2 in one or more body region. Results A total of 213 patients were included in the study, with a mean age of 7.8 years (standard deviation [SD]: 5.2 years). The most common cause of injury was vehicle related incidents (46%). The median length of hospital stay was 5 days (interquartile range [IQR]: 4-10 days). Approximately half (52%) of the patients had to stay in the intensive care unit, for a median of 1 day (IQR: 0-2 days). The mortality rate was 6.6%. The mean injury severity score was 19 (SD: 10). Pearson's correlation coefficient showed a positive correlation for injury severity score with length of stay in hospital (p<0.001). Conclusions There is significant variation in mechanism of injury, severity and pattern of paediatric trauma across age groups. A multidisciplinary team approach is imperative, and patients should be managed in specialist centres to optimise their care and eventual functional recovery. Head injury remained the most common, with significant mortality in all age groups. Rib fractures and pelvic fractures should be considered a marker for the severity of injury, and should alert doctors to look for other associated injuries.

  15. Traumatic thoracolumbar spine fractures

    NARCIS (Netherlands)

    J. Siebenga (Jan)

    2013-01-01

    textabstractTraumatic spinal fractures have the lowest functional outcomes and the lowest rates of return to work after injury of all major organ systems.1 This thesis will cover traumatic thoracolumbar spine fractures and not osteoporotic spine fractures because of the difference in fracture

  16. Fractures in multiple sclerosis

    DEFF Research Database (Denmark)

    Stenager, E; Jensen, K

    1991-01-01

    In a cross-sectional study of 299 MS patients 22 have had fractures and of these 17 after onset of MS. The fractures most frequently involved the femoral neck and trochanter (41%). Three patients had had more than one fracture. Only 1 patient had osteoporosis. The percentage of fractures increase...

  17. Ethical dimensions of paediatric nursing: A rapid evidence assessment.

    Science.gov (United States)

    Bagnasco, Annamaria; Cadorin, Lucia; Barisone, Michela; Bressan, Valentina; Iemmi, Marina; Prandi, Marzia; Timmins, Fiona; Watson, Roger; Sasso, Loredana

    2018-02-01

    Paediatric nurses often face complex situations requiring decisions that sometimes clash with their own values and beliefs, or with the needs of the children they care for and their families. Paediatric nurses often use new technology that changes the way they provide care, but also reduces their direct interaction with the child. This may generate ethical issues, which nurses should be able to address in the full respect of the child. Research question and objectives: The purpose of this review is to describe the main ethical dimensions of paediatric nursing. Our research question was, 'What are the most common ethical dimensions and competences related to paediatric nursing?' A rapid evidence assessment. According to the principles of the rapid evidence assessment, we searched the PubMed, SCOPUS and CINAHL databases for papers published between January 2001 and March 2015. These papers were then independently read by two researchers and analysed according to the inclusion criteria. Ethical considerations: Since this was a rapid evidence assessment, no approval from the ethics committee was required. Ten papers met our inclusion criteria. Ethical issues in paediatric nursing were grouped into three areas: (a) ethical issues in paediatric care, (b) social responsibility and (c) decision-making process. Few studies investigate the ethical dimensions and aspects of paediatric nursing, and they are mainly qualitative studies conducted in critical care settings based on nurses' perceptions and experiences. Paediatric nurses require specific educational interventions to help them resolve ethical issues, contribute to the decision-making process and fulfil their role as advocates of a vulnerable population (i.e. sick children and their families). Further research is needed to investigate how paediatric nurses can improve the involvement of children and their families in decision-making processes related to their care plan.

  18. Assessment of fracture risk

    International Nuclear Information System (INIS)

    Kanis, John A.; Johansson, Helena; Oden, Anders; McCloskey, Eugene V.

    2009-01-01

    Fractures are a common complication of osteoporosis. Although osteoporosis is defined by bone mineral density at the femoral neck, other sites and validated techniques can be used for fracture prediction. Several clinical risk factors contribute to fracture risk independently of BMD. These include age, prior fragility fracture, smoking, excess alcohol, family history of hip fracture, rheumatoid arthritis and the use of oral glucocorticoids. These risk factors in conjunction with BMD can be integrated to provide estimates of fracture probability using the FRAX tool. Fracture probability rather than BMD alone can be used to fashion strategies for the assessment and treatment of osteoporosis.

  19. STUDY ABOUT CLINICAL APPLICATION OF BRAIN ATLAS IN PAEDIATRICS

    Institute of Scientific and Technical Information of China (English)

    MENG Fanhang; LIU Cuiping; RENG Xiaoping; JIANG Lian

    2002-01-01

    Objectives To explore clinical application on brain atlas in paediatrics. Methode: Brain atlas was applied in diagnosis and treatment of paediatric diseases and its clinical value was discussed in 1990 ~2001. The manifestation of these diseases in brain atlas were analysed and the manifestation of CT of 67 cases and manifestations of EEG of 37 cases with that of BA were compared. Results The changes of cerebral electrical activity of these diseases were reflected objectively and showed directly in BA. Conclusion Brain atlas not only can point out quality of disease but also define position of disease. Therefore, brain atlas has important clinical value in paediatrics.

  20. Optimization of paediatric radiation doses with CR systems

    International Nuclear Information System (INIS)

    Zatelli, Giovanna; Mazzocchi, S.; Ciccarone, A.; Fonda, C.; De Otto, G.

    2008-01-01

    Full text: Radiation protection of paediatric patients is a primary objective in paediatric radiology due the higher life expectance of the little patients undergoing radiology examinations and due to the higher radiosensitivity of tissues. Aim of this work is the study of the optimization process in paediatric doses needed after the recent installation of a new Computed Radiography System in the Radiology of the Meyer paediatric Hospital, in Florence, Italy. This process involves both the use of new dedicated digitizer (Agfa DX-S) and elaboration software (Agfa NX2.0). The choice of the DX-S systems has been performed in consideration of high resolution (Scanhead technology - DirectriX detector), image sharpness and portability of the cassettes that make DX-S ideal in paediatric applications as neonatal intensive care. The NX software for image processing has been installed with the 'Paediatric' licence that optimizes paediatric images especially for exposures of premature newborns. Paediatric NX automatically selects the paediatric age group, depending on the patient's birth date. Each age group contains enhanced algorithms and settings adapted to age group, for optimized visibility of fine details. All the CR system has been accepted by mean of quality control acceptance tool AGFA AutoQC2, and all the automatic exposure control devices installed on radiographic devices were previously calibrated in accordance to literature with signal to noise vs dose considerations [S. Mazzocchi et al. 'AEC set-up optimization with computed radiography imaging' Radiat. Prot. Dosim. 117, 169-173 2005]. Paediatric patients were then divided into age-weight categories and the Entrance Surface Doses (ESD) were calculated by output x-rays measurements. ESD for thorax examinations were correlated to the image evaluations performed by experienced radiologists following European Guidelines on quality criteria for diagnostic radiographic images in paediatrics (EUR 16261, European

  1. Paratrooper's ankle fracture: posterior malleolar fracture.

    Science.gov (United States)

    Young, Ki Won; Kim, Jin-su; Cho, Jae Ho; Kim, Hyung Seuk; Cho, Hun Ki; Lee, Kyung Tai

    2015-03-01

    We assessed the frequency and types of ankle fractures that frequently occur during parachute landings of special operation unit personnel and analyzed the causes. Fifty-six members of the special force brigade of the military who had sustained ankle fractures during parachute landings between January 2005 and April 2010 were retrospectively analyzed. The injury sites and fracture sites were identified and the fracture types were categorized by the Lauge-Hansen and Weber classifications. Follow-up surveys were performed with respect to the American Orthopedic Foot and Ankle Society ankle-hindfoot score, patient satisfaction, and return to preinjury activity. The patients were all males with a mean age of 23.6 years. There were 28 right and 28 left ankle fractures. Twenty-two patients had simple fractures and 34 patients had comminuted fractures. The average number of injury and fractures sites per person was 2.07 (116 injuries including a syndesmosis injury and a deltoid injury) and 1.75 (98 fracture sites), respectively. Twenty-three cases (41.07%) were accompanied by posterior malleolar fractures. Fifty-five patients underwent surgery; of these, 30 had plate internal fixations. Weber type A, B, and C fractures were found in 4, 38, and 14 cases, respectively. Based on the Lauge-Hansen classification, supination-external rotation injuries were found in 20 cases, supination-adduction injuries in 22 cases, pronation-external rotation injuries in 11 cases, tibiofibular fractures in 2 cases, and simple medial malleolar fractures in 2 cases. The mean follow-up period was 23.8 months, and the average follow-up American Orthopedic Foot and Ankle Society ankle-hindfoot score was 85.42. Forty-five patients (80.36%) reported excellent or good satisfaction with the outcome. Posterior malleolar fractures occurred in 41.07% of ankle fractures sustained in parachute landings. Because most of the ankle fractures in parachute injuries were compound fractures, most cases had to

  2. Paediatric mild head injury: is routine admission to a tertiary trauma hospital necessary?

    Science.gov (United States)

    Tallapragada, Krishna; Peddada, Ratna Soundarya; Dexter, Mark

    2018-03-01

    Previous studies have shown that children with isolated linear skull fractures have excellent clinical outcomes and low risk of surgery. We wish to identify other injury patterns within the spectrum of paediatric mild head injury, which need only conservative management. Children with low risk of evolving neurosurgical lesions could be safely managed in primary hospitals. We retrospectively analysed all children with mild head injury (i.e. admission Glasgow coma score 13-15) and skull fracture or haematoma on a head computed tomography scan admitted to Westmead Children's Hospital, Sydney over the years 2009-2014. Data were collected regarding demographics, clinical findings, mechanism of injury, head computed tomography scan findings, neurosurgical intervention, outcome and length of admission. Wilcoxon paired test was used with P value <0.05 considered significant. Four hundred and ten children were analysed. Three hundred and eighty-one (93%) children were managed conservatively, 18 (4%) underwent evacuation of extradural haematoma (TBI surgery) and 11 (3%) needed fracture repair surgery. Two children evolved a surgical lesion 24 h post-admission. Only 17 of 214 children transferred from peripheral hospitals needed neurosurgery. Overall outcomes: zero deaths, one needed brain injury rehabilitation and 63 needed child protection unit intervention. Seventy-five percentage of children with non-surgical lesions were discharged within 2 days. Eighty-three percentage of road transfers were discharged within 3 days. Children with small intracranial haematomas and/or skull fractures who need no surgery only require brief inpatient symptomatic treatment and could be safely managed in primary hospitals. Improved tertiary hospital transfer guidelines with protocols to manage clinical deterioration could have cost benefit without risking patient safety. © 2017 Royal Australasian College of Surgeons.

  3. Relationship Ethics Between Paediatric Nurses and Patients

    Directory of Open Access Journals (Sweden)

    O. E. Baksansky

    2015-01-01

    Full Text Available The article deals with the problem of establishing communication between the paediatric nursing staff and their patients. It emphasizes the vital role of communication in the treatment process; analyzes the communication types and the typology of nurses offered by R. I. Hardy. The article shows how important the skill of understanding and listening to the patient is and what positive effect it has on establishing a psychological contact. Qualities obligatory for a nurse include patience and the ability to control oneself. This is hard to achieve because of a high degree of emotional stress, which arises as a result of communicating with patients, along with an increased irritability, exactingness and ailing touchiness. In the end, the personality, the style and methods of work and professional characteristics of a medical nurse are a necessary element of effective treatment together with correct diagnostics and prescriptions.

  4. [Paediatric retinal detachment and hereditary vitreoretinal disorders].

    Science.gov (United States)

    Meier, P

    2013-09-01

    The number of retinal detachments in children is very low in comparison to the number in adults. One predisposing factor for development of paediatric retinal detachment is suffering from hereditary vitreoretinal degeneration (e.g., Stickler syndrome, Wagner syndrome, Kniest dysplasia, familial exudative vitreoretinopathy, congenital X-linked retinoschisis, Knobloch syndrome, incontinentia pigmenti, Norrie disease). Hereditary vitreoretinopathies are characterised by an abnormal-appearing vitreous gel with associated retinal changes. In most of these eyes further ocular abnormalities can be diagnosed. A group of hereditary disorders is associated with characteristic systemic abnormalities. Allied conditions should be considered in the clinical diagnosis. Vitreoretinopathies are the most common cause of inherited retinal detachment. In most eyes primary vitrectomy is necessary, and disease-specific surgical treatment is discussed. Georg Thieme Verlag KG Stuttgart · New York.

  5. Paediatric Crohn's disease: a radiological review

    International Nuclear Information System (INIS)

    Ali, S.I.; Carty, H.M.L.

    2000-01-01

    Paediatric Crohn's disease can be a serious and complex condition which is not always easy to diagnose if it presents in an atypical manner. Although the pathological processes are the same in adults and children, the clinical presentation and disease distribution can be different in children. The impact of the disease can also be much more significant in a growing and developing child than in an adult. Numerous investigations are available to establish the diagnosis, define the complications and to demonstrate the extra-intestinal manifestations. Close co-operation is required between the clinician and radiologist when investigating a child suspected of having Crohn's disease or its symptoms to minimise the radiation dose and the psychological and physical trauma. We review the clinical and radiological aspects of Crohn's disease and discuss the imaging modalities available in diagnosing Crohn's disease and its complications and suggest an investigation pathway as used in our institution. (orig.)

  6. New hazards in paediatric poisoning presentations.

    LENUS (Irish Health Repository)

    Moore, C

    2015-02-01

    Accidental ingestion is an important preventable cause of childhood morbidity. All accidental ingestion presentations (n = 478) to a tertiary paediatric ED from January 2010 to December 2011 were analysed. These results were compared with a similar study in the same institution ten years previously in 2001 and showed that while accidental ingestions constituted a higher proportion of presentations (0.5% in this study v 0.45% in 2001), fewer had investigations performed (21% v 35%) and fewer were admitted (7% v 20%). Accidental ingestions account for 0.5% of presentations and are an important focus of home safety information for parents and guardians. Paracetamol (n = 67, 14%) and liquid detergent capsules (n = 44, 9.2%) were the two most common substances implicated in these presentations, and have the potential to cause severe morbidity and mortality.

  7. Ibuprofen in paediatrics: pharmacology, prescribing and controversies.

    Science.gov (United States)

    Moriarty, Camilla; Carroll, Will

    2016-12-01

    Ibuprofen, a propionic acid derivative, is a non-steroidal anti-inflammatory drug. The oral formulation is widely used in paediatric practice and after paracetamol it is one of the most common drugs prescribed for children in hospital. The treatment of fever with antipyretics such as ibuprofen is controversial as fever is the normal response of the body to infection and unless the child becomes distressed or symptomatic, fever alone should not be routinely treated. Combined treatment with paracetamol and ibuprofen is commonly undertaken but almost certainly is not helpful. This article aims to describe the indications and mode of action of the drug, outline its pharmacokinetics and highlight the important key messages regarding its use in clinical practice. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  8. Sedation for paediatric auditory electrophysiology in South Africa

    African Journals Online (AJOL)

    emergency departments and nuclear medicine.1 Added to this is the periodic need ... electrophysiology in the paediatric population in South Africa were not found. ..... to inadequate information technology infrastructure as well as limited data ...

  9. Cost Burden for Accessing Paediatric Emergency Services at a ...

    African Journals Online (AJOL)

    TNHJOURNALPH

    modalities and economic impacts for accessing paediatric ... Descriptive analysis of the data was done using SPSS ... being discharged home from the emergency ... their homes to the hospital. ..... respondents could be affected by recall bias.

  10. The spectrum and outcome of paediatric traumatic brain injury in ...

    African Journals Online (AJOL)

    The spectrum and outcome of paediatric traumatic brain injury in ... to develop a comprehensive overview of traumatic brain injury (TBI) in children ... We reviewed the age, gender, outcomes, radiological findings and treatment of the patients.

  11. African Journal of Paediatric Surgery - Vol 10, No 2 (2013)

    African Journals Online (AJOL)

    Histopathological review of breast tumours in children and adolescents in Delta ... of early and late oral feeding in intestinal anastomosis surgeries in children ... Paediatric urologic pathologies at the national teaching hospital in Cotonou: A ...

  12. Multidetector row CT for imaging the paediatric tracheobronchial tree

    International Nuclear Information System (INIS)

    Papaioannou, Georgia; Young, Carolyn; Owens, Catherine M.

    2007-01-01

    The introduction of multidetector row computed tomography (MDCT) scanners has altered the approach to imaging the paediatric thorax. In an environment where the rapid acquisition of CT data allows general hospitals to image children instead of referring them to specialist paediatric centres, it is vital that general radiologists have access to protocols appropriate for paediatric applications. Thus a dramatic reduction in the delivered radiation dose is ensured with optimal contrast bolus delivery and timing, and inappropriate repetition of the scans is avoided. This article focuses on the main principles of volumetric CT imaging that apply generically to all MDCT scanners. We describe the reconstruction techniques for imaging the paediatric thorax and the low-dose protocols used in our institution on a 16-slice detector CT scanner. Examples of the commonest clinical applications are also given. (orig.)

  13. Paediatric population neuroimaging and the Generation R Study

    DEFF Research Database (Denmark)

    White, Tonya; Muetzel, Ryan L.; El Marroun, Hanan

    2018-01-01

    Paediatric population neuroimaging is an emerging field that falls at the intersection between developmental neuroscience and epidemiology. A key feature of population neuroimaging studies involves large-scale recruitment that is representative of the general population. One successful approach f...

  14. audit of blood transfusion practices in the paediatric medical ward

    African Journals Online (AJOL)

    2013-01-01

    Jan 1, 2013 ... AUDIT OF BLOOD TRANSFUSION PRACTICES IN THE PAEDIATRIC MEDICAL WARD OF A TERTIARY ..... services and even where available, beneficiaries have ... due to lack of existence of quality assurance protocol.

  15. EAP viewpoint on unpublished data from paediatric clinical trials.

    Science.gov (United States)

    Schrier, L; Illy, K; Valiulis, A; Wyder, C; Stiris, T

    2018-02-01

    European children and paediatricians rely heavily on the fair, complete and timely publication of data obtained from paediatric randomised controlled trials (RCTs). Selective publication and reporting of paediatric RCTs is common practice. Industry-sponsored trials are more likely to remain unpublished, and take longer to get published compared with trials sponsored by others. However, also academic sponsors contribute to inefficiencies in publishing clinical data. Publication bias violates the ethical obligation that investigators have towards study participants, leads to considerable inefficiencies in research and a waste of financial and human resources, and has the potential to distort evidence for treatment approaches. The European Academy of Paediatrics (EAP) therefore actively supports initiatives that increase the public dissemination of paediatric clinical trial data. The EAP will raise awareness about the guidelines for Good Publication Practice among European paediatricians and subspecialty societies.

  16. Clinical features of paediatric pulmonary hypertension : a registry study

    NARCIS (Netherlands)

    Berger, Rolf M. F.; Beghetti, Maurice; Humpl, Tilman; Raskob, Gary E.; Ivy, D. Dunbar; Jing, Zhi-Cheng; Bonnet, Damien; Schulze-Neick, Ingram; Barst, Robyn J.

    2012-01-01

    Background Paediatric pulmonary hypertension, is an important cause of morbidity and mortality, and is insufficiently characterised in children. The Tracking Outcomes and Practice in Pediatric Pulmonary Hypertension (TOPP) registry is a global, prospective study designed to provide information about

  17. Radiopharmaceutical activities administered for paediatric nuclear medicine procedures in Australia

    International Nuclear Information System (INIS)

    Towson, J.E.; Smart, R.C.; Rossleigh, M.A.; Children's Hospital, Randwick, NSW

    2000-01-01

    A survey of radiopharmaceutical activities used at the eight hospital centres specialising in paediatric nuclear medicine in Australia was conducted in 1999-2000 by the Australian and New Zealand Society of Nuclear Medicine and the Australasian Radiation Protection Society. Data on the maximum and minimum administered activities was obtained for 43 paediatric imaging procedures. The maximum values were significantly less than the corresponding Reference Activities for adults determined in a previous study. Activities for individual patients are calculated using surface area scaling at five centres and body weight scaling at three centres. The median values of A max and A min are recommended as Paediatric Reference Activities. The effective dose to patients of various sizes for the Paediatric Reference Activities and both methods of scaling was calculated for each procedure. Copyright (2000) Australasian Radiation Protection Society Inc

  18. Paediatric retinal detachment: aetiology, characteristics and outcomes

    Directory of Open Access Journals (Sweden)

    Elizabeth McElnea

    2018-02-01

    Full Text Available AIM: To provide contemporary data on the aetiology, clinical features and outcomes of paediatric retinal detachment. METHODS: A retrospective review of all those under 16y who underwent surgical repair for retinal detachment at a single centre between the years 2008 and 2015 inclusive was performed. In each case the cause of retinal detachment, the type of detachment, the presence or absence of macular involvement, the number and form of reparative surgeries undertaken, and the surgical outcome achieved was recorded. RESULTS: Twenty-eight eyes of 24 patients, 15 (62.5% of whom were male and 9 (37.5% of whom were female, their mean age being 11.6y and range 2-16y developed retinal detachment over the eight year period studied. Trauma featured in the development of retinal detachment in 14 (50.0% cases. Retinal detachment was associated with other ocular and/or systemic conditions in 11 (39.3% cases. A mean of 3.0 procedures with a range of 1-9 procedures per patient were undertaken in the management of retinal detachment. Complex vitrectomy combined with scleral buckling or complex vitrectomy alone were those most frequently performed. Mean postoperative visual acuity was 1.2 logMAR with range 0.0-3.0 logMAR. In 22 of 26 (84.6% cases which underwent surgical repair the retina was attached at last follow-up. CONCLUSION: Aggressive management of paediatric retinal detachment including re-operation increases the likelihood of anatomical success. In cases where the retinal detachment can be repaired by an external approach alone there is a more favourable visual outcome.

  19. Paediatric retinal detachment: aetiology, characteristics and outcomes.

    Science.gov (United States)

    McElnea, Elizabeth; Stephenson, Kirk; Gilmore, Sarah; O'Keefe, Michael; Keegan, David

    2018-01-01

    To provide contemporary data on the aetiology, clinical features and outcomes of paediatric retinal detachment. A retrospective review of all those under 16y who underwent surgical repair for retinal detachment at a single centre between the years 2008 and 2015 inclusive was performed. In each case the cause of retinal detachment, the type of detachment, the presence or absence of macular involvement, the number and form of reparative surgeries undertaken, and the surgical outcome achieved was recorded. Twenty-eight eyes of 24 patients, 15 (62.5%) of whom were male and 9 (37.5%) of whom were female, their mean age being 11.6y and range 2-16y developed retinal detachment over the eight year period studied. Trauma featured in the development of retinal detachment in 14 (50.0%) cases. Retinal detachment was associated with other ocular and/or systemic conditions in 11 (39.3%) cases. A mean of 3.0 procedures with a range of 1-9 procedures per patient were undertaken in the management of retinal detachment. Complex vitrectomy combined with scleral buckling or complex vitrectomy alone were those most frequently performed. Mean postoperative visual acuity was 1.2 logMAR with range 0.0-3.0 logMAR. In 22 of 26 (84.6%) cases which underwent surgical repair the retina was attached at last follow-up. Aggressive management of paediatric retinal detachment including re-operation increases the likelihood of anatomical success. In cases where the retinal detachment can be repaired by an external approach alone there is a more favourable visual outcome.

  20. A concept analysis of holistic nursing care in paediatric nursing

    OpenAIRE

    A.A. Tjale; J. Bruce

    2007-01-01

    Holistic nursing care is widely advocated and is espoused in the philosophy of the South African Nursing Council. This concept is unclear, variously interpreted and poorly understood in paediatric nursing. This study was undertaken to examine the meaning of holistic nursing care and to develop a framework for holistic nursing care, which can be utilised in nurse education settings and in clinical nursing practice in the context of paediatric nursing. A qualitative, interpretive, explorative a...

  1. Tape measure to aid prescription in paediatric resuscitation.

    OpenAIRE

    Hughes, G; Spoudeas, H; Kovar, I Z; Millington, H T

    1990-01-01

    A tape measure, based on 50th centile weight for height and designed to permit easy drug dosage calculation, endotracheal tube size and DC cardioversion current dosages in childrens' emergencies, was tested for reliability by medical and nursing staff with varying paediatric experience. We found that the tape measure gave a reproducible estimate of weight and suggest that its use would facilitate decision making by inexperienced medical and nursing staff in paediatric resuscitation when there...

  2. Report of the Paediatric Nurse Education Review Group

    OpenAIRE

    Department of Health (Ireland)

    2000-01-01

    10.12.2000 The Department of Health and Children is implementing the recommendations of the Commission on Nursing (1998). It agreed with the Nursing Alliance in early 2000 to set up working groups to inform the implementation of specific recommendations in relation to nurse education. One of these working groups was to address paediatric nurse education. In March 2000, a Steering Group to oversee a review of paediatric nurse education was convened and the following terms of reference agre...

  3. Paediatric cyclical Cushing's disease due to corticotroph cell hyperplasia.

    LENUS (Irish Health Repository)

    Noctor, E

    2015-06-01

    Cushing\\'s disease is very rare in the paediatric population. Although uncommon, corticotroph hyperplasia causing Cushing\\'s syndrome has been described in the adult population, but appears to be extremely rare in children. Likewise, cyclical cortisol hypersecretion, while accounting for 15 % of adult cases of Cushing\\'s disease, has only rarely been described in the paediatric population. Here, we describe a very rare case of a 13-year old boy with cyclical cortisol hypersecretion secondary to corticotroph cell hyperplasia.

  4. Paediatric Pain Management: Using Complementary and Alternative Medicine

    OpenAIRE

    Evans, Subhadra; Tsao, Jennie C.I; Zeltzer, Lonnie K.

    2008-01-01

    Children undergo acute painful procedures and many also experience chronic pain.Due to their developing systems, infants and children may be at greater risk than adults for protracted pain sensitivity.There is a need to manage acute and chronic paediatric pain to reduce children's suffering and to prevent future pain problems.Consistent with a biopsychosocial perspective, complementary and alternative medicine (CAM) should be considered in management of acute and chronic paediatric pain.Altho...

  5. Fracture mechanical materials characterisation

    International Nuclear Information System (INIS)

    Wallin, K.; Planman, T.; Nevalainen, M.

    1998-01-01

    The experimental fracture mechanics development has been focused on the determination of reliable lower-bound fracture toughness estimates from small and miniature specimens, in particular considering the statistical aspects and loading rate effects of fracture mechanical material properties. Additionally, materials aspects in fracture assessment of surface cracks, with emphasis on the transferability of fracture toughness data to structures with surface flaws have been investigated. Further a modified crack-arrest fracture toughness test method, to increase the effectiveness of testing, has been developed. (orig.)

  6. Paediatric stoma care nursing in the UK and Ireland.

    Science.gov (United States)

    Waller, Marie

    Improving quality of care and developing and maintaining high standards of care are issues that are high on the NHS, nursing, and paediatric care agendas. Stoma formation will have an impact on the wellbeing and lifestyle of the person and their family, whatever the person's age. The specialty of stoma care nursing in the UK and Ireland is well established. However, the sub-specialty of paediatric stoma care nursing is much smaller in its 'membership' and its client group. There are differences in the needs of, and the associated care of, paediatric stoma patients even within this overall patient group. Paediatric stoma care nurses are in an ideal position to increase awareness about the specialty and improve standards of nursing care for neonates, children, adolescents and their families. However, until the establishment of the Paediatric Stoma Nurse Group (PSNG) in 2005, this 'position' had not being utilized. This article discusses the ongoing work of the PSNG to devise standards of paediatric stoma care nursing, best practice guidelines, relevant patient/parental information and establish itself as a valuable, proactive and independent forum for all healthcare professionals involved in the care of children with stomas.

  7. Fast tracking in paediatric cardiac anaesthesia : an update.

    Directory of Open Access Journals (Sweden)

    Lake Carol

    2002-01-01

    Full Text Available A care plan in which cardiac surgical patients progress quickly through the perioperative course to hospital discharge is often referred to as a Fast Track. Such care plans have been used extensively in adult cardiac patients but are also applicable to paediatric patients. Although no randomised controlled trials are available to document a reduction in hospital costs and avoidance of iatrogenic complications with paediatric fast tracks, many healthcare administrators encourage their use. Fast Track clinical guidelines usually include same day surgery, use of short- acting anaesthetic drugs, early extubation, effective pain management, and reduced intensive care unit stays. These protocols are certainly appropriate for simple procedures such as repair of atrial or ventricular septal defects or ligation of a patent ductus arteriosus. However, many paediatric cardiac anaesthesiologists consider that all paediatric patients without significant pulmonary or residual cardiac pathology can be managed using expedited postoperative protocols. Essential components in a "fast track" protocol include use of minimally invasive surgical techniques, modified ultrafiltration during cardiopulmonary bypass, transoesophageal echocardiography to evaluate the cardiac repair, and postoperative pain control. Using such techniques, 80-90% of paediatric patients can be extubated in the operating room or within 2-4 hours postoperatively. Despite the opinions of recognised experts, an appropriately sized and powered multicentre, controlled, randomised, prospective study is still needed to conclusively document the efficiency and effectiveness of the Fast Track in paediatric cardiac patients.

  8. Management of paediatric spontaneous pneumothorax: a multicentre retrospective case series.

    Science.gov (United States)

    Robinson, Paul D; Blackburn, Carol; Babl, Franz E; Gamage, Lalith; Schutz, Jacquie; Nogajski, Rebecca; Dalziel, Stuart; Donald, Colin B; Druda, Dino; Krieser, David; Neutze, Jocelyn; Acworth, Jason; Lee, Mark; Ngo, Peter K

    2015-10-01

    Paediatric guidelines are lacking for management of spontaneous pneumothorax. Adult patient-focused guidelines (British Thoracic Society 2003 and 2010) introduced aspiration as first-line intervention for primary spontaneous pneumothorax (PSP) and small secondary spontaneous pneumothoraces (SSP). Paediatric practice is unclear, and evidence for aspiration success rates is urgently required to develop paediatric-specific recommendations. Retrospective analysis of PSP and SSP management at nine paediatric emergency departments across Australia and New Zealand (2003-2010) to compare PSP and SSP management. 219 episodes of spontaneous pneumothorax occurred in 162 children (median age 15 years, 71% male); 155 PSP episodes in 120 children and 64 SSP episodes in 42 children. Intervention in PSP vs SSP episodes occurred in 55% (95% CI 47% to 62%) vs 70% (60% to 79%), pmanagement, PSP and SSP management did not differ and ICC insertion was the continuing preferred intervention. Overall success of aspiration was lower than reported results for adults, although success was greater for small than for large pneumothoraces. Paediatric prospective studies are urgently required to determine optimal paediatric interventional management strategies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  9. Survey on sedation in paediatric dentistry: a global perspective.

    Science.gov (United States)

    Wilson, Stephen; Alcaino, Eduardo A

    2011-09-01

    Paediatric dentists receive training in sedation during their advanced education training, but evidence suggests that this training varies widely. The purpose of this study was to survey members of the International Association of Paediatric Dentistry (IAPD) and the European Academy of Paediatric Dentistry (EAPD) on their opinion on pharmacological and other behavioural management techniques and their training related to provision of oral health care of paediatric patients in the dental setting. A request was made for access to the IAPD and EAPD membership email addresses. The responses were recorded anonymously and data uploaded into spss (version 9) and analysed using descriptive analysis and chi-square with and without tabulation processes. A total of 311 respondents of 1973 targeted individuals answered the survey. The response rate was 16%. The majority of the respondents came from the continent of Europe, Asia, and the Americas. The most frequent type of sedation was general anaesthesia (52% of the respondents), followed by nitrous oxide (46%) and then oral sedation (44%). At least 91% of the respondents indicated that they were interested in the development of continuing education on the topic of sedation. Paediatric dentists around the world use relatively few behaviour management techniques, including pharmacological management. There is a definite interest in continuing education in the area of sedation. The Authors. International Journal of Paediatric Dentistry © 2011 BSPD, IAPD and Blackwell Publishing Ltd.

  10. Bed Utilisation in an Irish Regional Paediatric Unit A Cross-Sectional Study Using the Paediatric Appropriateness Evaluation Protocol (PAEP)

    LENUS (Irish Health Repository)

    Ó hAiseadha, Coilín

    2016-05-01

    Increasing demand for limited healthcare resources raises questions about appropriate use of inpatient beds. In the first paediatric bed utilisation study at a regional university centre in Ireland, we conducted a cross-sectional study to audit the utilisation of inpatient beds at the Regional Paediatric Unit (RPU) in University Hospital Limerick (UHL), Limerick, Ireland and also examined hospital activity data, to make recommendations for optimal use of inpatient resources.

  11. Fractures (Broken Bones): First Aid

    Science.gov (United States)

    First aid Fractures (broken bones) Fractures (broken bones): First aid By Mayo Clinic Staff A fracture is a ... 10, 2018 Original article: http://www.mayoclinic.org/first-aid/first-aid-fractures/basics/ART-20056641 . Mayo Clinic ...

  12. Fingertip injuries in paediatric patients ---- experiences at an emergency centre in Saudi Arabia

    International Nuclear Information System (INIS)

    Anazi, A.F.A.

    2013-01-01

    Objectives: To investigate the etiological factors, intensity of injuries and the possible preventive measures of fingertip injuries and to avert such calamities. Methods: A study was undertaken retrospectively on 200 children who had presented with fingertip injuries to the Paediatric Emergency Department of the King Saud bin Abdulaziz University for Health Sciences, during the years 2010-2011. The markers analyzed included age and sex of the patients, period when the injury occurred (vacation and/or non-vacation), accommodation, where the children dwelled, source of injury, localization of the injury, fracture or tendon damage, and modality of treatment. Results: The frequency of injuries was highest among younger children (< 5 years). Majority of injuries were found to occur during vacation period among patients who dwell in apartments and villas at residential compounds. House doors were the most common mode of crush injuries. The frequency of fractures was found to be more frequent in boys vs. girls. Suturing and conservative treatment were common mode of treatments. Of the total, 188 patients who attended the emergency had proper movement and alignment by the end of their treatment, while 12 patients demonstrated complications. Conclusion: Children below 5 years age were involved in fingertip injuries in a large number. Injuries were more common in vacations and in children living in appartments. Preventive measures are necessary to avoid these accidents. (author)

  13. Fracture toughness correlations

    International Nuclear Information System (INIS)

    Wallin, Kim

    1986-09-01

    In this study existing fracture parameter correlations are reviewed. Their applicability and reliability are discussed in detail. A new K IC -CVN-correlation, based on a theoretical brittle fracture model, is presented

  14. Rib fracture - aftercare

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000539.htm Rib fracture - aftercare To use the sharing features on this page, please enable JavaScript. A rib fracture is a crack or break in one or ...

  15. Sprains, Strains and Fractures

    Science.gov (United States)

    ... fractures. Many fractures and sprains occur during sports. Football players are particularly vulnerable to foot and ankle ... feet and ankles and take a complete medical history. He or she will also order tests, including ...

  16. Infant skull fracture (image)

    Science.gov (United States)

    Skull fractures may occur with head injuries. Although the skull is both tough and resilient and provides excellent ... or blow can result in fracture of the skull and may be accompanied by injury to the ...

  17. Ankle fracture - aftercare

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000548.htm Ankle fracture - aftercare To use the sharing features on this page, please enable JavaScript. An ankle fracture is a break in 1 or more ankle ...

  18. Immobilisation in Australian paediatric medical imaging: A pilot study

    International Nuclear Information System (INIS)

    Noonan, S.; Spuur, K.; Nielsen, S.

    2017-01-01

    Aims: The primary aim of this study is to document the use of paediatric immobilisation techniques in medical imaging. Secondary aims are to investigate differences between current practice of paediatric and non-paediatric facilities and radiographer gender and to investigate immobilisation protocols. Methods: A SurveyMonkey link was distributed through the Australian Society of Medical Imaging and Radiation Therapy (ASMIRT) newsletter. Radiographer members of ASMIRT were invited to participate. Frequency percentage analysis was undertaken; as the 'frequency of immobilisation' response was on a Likert scale and the ages categorical, a Fisher's exact test could determine dependency. Results: The use of paediatric immobilisation techniques was determined to be related to age. The most commonly used technique in general X-ray was “other people”; in computed tomography, Velcro, verbal reminders and distraction techniques; and in magnetic resonance imaging, sedation and Velcro. A comparison of immobilisation techniques demonstrated that Velcro use in X-ray was dependent on facility (p = 0.017) with paediatric facilities using it up to 17 years. Immobilisation frequency was dependent in 13–17 years (p = 0.035) with paediatric facilities rarely immobilising and non-paediatric facilities never. No dependencies resulted upon comparing genders. Immobilisation frequency was not dependent between protocols or current practice. Conclusion: The use of paediatric immobilisation technique is related to age with “other people”, sedation, Velcro, verbal reminders and distraction techniques being regularly used. The dependency of Velcro use and immobilisation frequency in 13–17 years is for unknown reasons and further investigation is required. A larger study should be carried out to validate these findings. - Highlights: • Document the use of paediatric immobilisation techniques in medical imaging. • Investigate differences in practice between

  19. Atraumatic First Rib Fracture

    OpenAIRE

    Koray Aydogdu

    2014-01-01

    Rib fractures are usually seen after a trauma, while atraumatic spontaneous rib fractures are quite rare. A first rib fracture identified in our 17 years old female patient who had not a history of trauma except lifting a heavy weight was examined in details in terms of the potential complications and followed-up for a long time. We presented our experience on this case with atraumatic first rib fracture that has different views for the etiology in light of the literature.

  20. Dose estimation for paediatric cranial computed tomography

    International Nuclear Information System (INIS)

    Curci Daros, K.A.; Bitelli Medeiros, R.; Curci Daros, K.A.; Oliveira Echeimberg, J. de

    2006-01-01

    In the last ten years, the number of paediatric computed tomography (CT) scans have increased worldwide, contributing to higher population radiation dose. Technique diversification in paediatrics and different CT equipment technologies have led to various exposure levels complicating precise evaluation of doses and operational conditions necessary for good quality images. The objective of this study was to establish a quantitative relationship between absorbed dose and cranial region in children up to 6 years old undergoing CT exams. Methods: X-ray was measured on the cranial surface of 64 patients undergoing CT using thermoluminescent (T.L.) dosimeters. Forty T.L.D.100 thermoluminescent dosimeters (T.L.D.) were evenly distributed on each patients skin surface along the sagittal axis. Measurements were performed in facial regions exposed to scatter radiation and in the supratentorial and posterior fossa regions, submitted to primary radiation. T.L.D. were calibrated for 120 kV X-ray over the acrylic phantom. T.L. measurements were made with a Harshaw 4000 system. Patient mean T.L. readings were determined for position, pi, of T.L.D. and normalized to the maximum supratentorial reading. From integrating the linear T.L. density function (?) resulting from radiation distribution in each of the three exposed regions, dose fraction was determined in the region of interest, along with total dose under the technical conditions used in that specific exam protocol. For each T.L.D. position along the patient cranium, there were n T.L. measurements with 2% uncertainty due to T.L. reader, and 5% due to thermal treatment of dosimeters. Also, mean T.L. readings and their uncertainties were calculated for each patient at each position, p. Results: Mean linear T.L. density for the region exposed to secondary radiation defined by position, 0.3≤p≤6 cm, was ρ((p)=7.9(4)x10 -2 +7(5)x10 -5 p 4.5(4) cm -1 ; exposed to primary X-ray for the posterior fossa region defined by position

  1. Dose estimation for paediatric cranial computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Curci Daros, K.A.; Bitelli Medeiros, R. [Sao Paulo Univ. Federal (Brazil); Curci Daros, K.A.; Oliveira Echeimberg, J. de [Centro Univ. Sao Camilo, Sao Paulo (Brazil)

    2006-07-01

    In the last ten years, the number of paediatric computed tomography (CT) scans have increased worldwide, contributing to higher population radiation dose. Technique diversification in paediatrics and different CT equipment technologies have led to various exposure levels complicating precise evaluation of doses and operational conditions necessary for good quality images. The objective of this study was to establish a quantitative relationship between absorbed dose and cranial region in children up to 6 years old undergoing CT exams. Methods: X-ray was measured on the cranial surface of 64 patients undergoing CT using thermoluminescent (T.L.) dosimeters. Forty T.L.D.100 thermoluminescent dosimeters (T.L.D.) were evenly distributed on each patients skin surface along the sagittal axis. Measurements were performed in facial regions exposed to scatter radiation and in the supratentorial and posterior fossa regions, submitted to primary radiation. T.L.D. were calibrated for 120 kV X-ray over the acrylic phantom. T.L. measurements were made with a Harshaw 4000 system. Patient mean T.L. readings were determined for position, pi, of T.L.D. and normalized to the maximum supratentorial reading. From integrating the linear T.L. density function (?) resulting from radiation distribution in each of the three exposed regions, dose fraction was determined in the region of interest, along with total dose under the technical conditions used in that specific exam protocol. For each T.L.D. position along the patient cranium, there were n T.L. measurements with 2% uncertainty due to T.L. reader, and 5% due to thermal treatment of dosimeters. Also, mean T.L. readings and their uncertainties were calculated for each patient at each position, p. Results: Mean linear T.L. density for the region exposed to secondary radiation defined by position, 0.3{<=}p{<=}6 cm, was {rho}((p)=7.9(4)x10{sup -2}+7(5)x10{sup -5}p{sup 4.5(4)} cm{sup -1}; exposed to primary X-ray for the posterior fossa

  2. Metatarsal stress fractures - aftercare

    Science.gov (United States)

    ... Metatarsal stress fracture. In: Safran MR, Zachazewski J, Stone DA, eds. Instructions for Sports Medicine Patients . 2nd ed. Elsevier Saunders; 2012:648-652. Smith MS. Metatarsal fractures. In: Eiff PM, Hatch R, eds. Fracture Management for Primary Care . 3rd ed. ...

  3. Relationships between fractures

    Science.gov (United States)

    Peacock, D. C. P.; Sanderson, D. J.; Rotevatn, A.

    2018-01-01

    Fracture systems comprise many fractures that may be grouped into sets based on their orientation, type and relative age. The fractures are often arranged in a network that involves fracture branches that interact with one another. Interacting fractures are termed geometrically coupled when they share an intersection line and/or kinematically coupled when the displacements, stresses and strains of one fracture influences those of the other. Fracture interactions are characterised in terms of the following. 1) Fracture type: for example, whether they have opening (e.g., joints, veins, dykes), closing (stylolites, compaction bands), shearing (e.g., faults, deformation bands) or mixed-mode displacements. 2) Geometry (e.g., relative orientations) and topology (the arrangement of the fractures, including their connectivity). 3) Chronology: the relative ages of the fractures. 4) Kinematics: the displacement distributions of the interacting fractures. It is also suggested that interaction can be characterised in terms of mechanics, e.g., the effects of the interaction on the stress field. It is insufficient to describe only the components of a fracture network, with fuller understanding coming from determining the interactions between the different components of the network.

  4. Obesity and fracture risk

    OpenAIRE

    Gonnelli, Stefano; Caffarelli, Carla; Nuti, Ranuccio

    2014-01-01

    Obesity and osteoporosis are two common diseases with an increasing prevalence and a high impact on morbidity and mortality. Obese women have always been considered protected against osteoporosis and osteoporotic fractures. However, several recent studies have challenged the widespread belief that obesity is protective against fracture and have suggested that obesity is a risk factor for certain fractures.

  5. Imaging of insufficiency fractures

    Energy Technology Data Exchange (ETDEWEB)

    Krestan, Christian [Department of Radiology, Medical University of Vienna, Vienna General Hospital, Waehringerstr. 18-20, 1090 Vienna (Austria)], E-mail: christian.krestan@meduniwien.ac.at; Hojreh, Azadeh [Department of Radiology, Medical University of Vienna, Vienna General Hospital, Waehringerstr. 18-20, 1090 Vienna (Austria)

    2009-09-15

    This review focuses on the occurrence, imaging and differential diagnosis of insufficiency fractures. Prevalence, the most common sites of insufficiency fractures and their clinical implications are discussed. Insufficiency fractures occur with normal stress exerted on weakened bone. Postmenopausal osteoporosis is the most common cause of insufficiency fractures. Other conditions which affect bone turnover include osteomalacia, hyperparathyroidism, chronic renal failure and high-dose glucocorticoid therapy. It is a challenge for the radiologist to detect and diagnose insufficiency fractures, and to differentiate them from other bone lesions. Radiographs are still the most widely used imaging method for identification of insufficiency fractures, but sensitivity is limited, depending on the location of the fractures. Magnetic resonance imaging (MRI) is a very sensitive tool to visualize bone marrow abnormalities associated with insufficiency fractures. Thin section, multi-detector computed tomography (MDCT) depicts subtle fracture lines allowing direct visualization of cortical and trabecular bone. Bone scintigraphy still plays a role in detecting fractures, with good sensitivity but limited specificity. The most important differential diagnosis is underlying malignant disease leading to pathologic fractures. Bone densitometry and clinical history may also be helpful in confirming the diagnosis of insufficiency fractures.

  6. Incidence of traumatic long-bone fractures requiring in-hospital management: a prospective age- and gender-specific analysis of 4890 fractures.

    Science.gov (United States)

    Meling, Terje; Harboe, Knut; Søreide, Kjetil

    2009-11-01

    Musculoskeletal trauma represents a considerable global health burden; however, reliable population-based incidence data are lacking. Thus, we prospectively investigated the age- and sex-specific incidence patterns of long-bone fractures in a defined population. A 4-year prospective study of all long-bone fractures in a defined Norwegian population was carried out. The demographic data, as well as data on fracture type and location and mode of treatment were collected using recognised classification (e.g., AO/OTA - Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association; Gustilo-Anderson (GA) for open fractures). Age- and sex-adjusted incidences were calculated using population statistics. During the study period, 4890 long-bone fractures were recorded. The overall incidence per 100,000 per year was 406 with a 95% confidence interval (95%CI) of 395-417. The age-adjusted incidence for those lower than that for those >or=16 years (427; 95%CI: 414-440). The overall male incidence (337; 95%CI: 322-355) was lower than the female (476; 95%CI: 459-493), but the male:female ratio was 2:1 among those or=50 years. The upper limb fractures had an overall incidence of 159 (95%CI: 152-166), whereas the lower limb fracture incidence was 247 (95%CI: 238-256). Open fractures occurred in 3%, with an incidence of 13 (95%CI: 11-15). Paediatric fractures were more likely to be treated conservatively with only 8% requiring internal fixation, compared to 56% internal fixation in those >or=16 years of age. An increase in the use of angular stable plates occurred during the study period. This prospectively collected study of long-bone fractures in a defined population recognises age- and gender-specific fracture patterns. Boys predominate in the younger age group for which treatment is basically conservative. In the senior population, women and operative treatment predominate.

  7. Paediatric acute epiglottitis: not a disappearing entity.

    Science.gov (United States)

    McEwan, John; Giridharan, Wijayasingham; Clarke, Raymond W; Shears, Paul

    2003-04-01

    Paediatric epiglottitis is a serious, potentially life-threatening condition. Since the widespread introduction of the Haemophilus influenzae type b (Hib) conjugate vaccine in the UK in October 1992, there has been a dramatic reduction in its incidence. Vaccine failure is rare. The purpose of this study is to examine the failure rate of H. influenzae type b vaccine as measured by the number of cases of Haemophilus epiglottitis in fully vaccinated children presenting to a tertiary paediatric centre. A secondary aim is to provide a retrospective review of all cases of epiglottitis over a 13-year period. A retrospective case-note review identifying all cases of epiglottitis presenting to Alder Hey Hospital was undertaken covering the time period December 1987-January 2001. Details of patient age, sex, source of referral, clinical presentation, management and complications along with microbiological and serological findings were obtained. There were 21 males and 19 females. The mean age was 36 months (range 6-125 months). A provisional diagnosis was made on the basis of the clinical features, confirmed by direct laryngoscopy in all but two cases and further supported in 28 cases by a positive blood culture. Of the 40 children presenting with epiglottitis, eight (20%) presented after the introduction of the Hib conjugate vaccine. H. influenzae antibody titres were measured both in the acute and convalescent phases of illness by the central Haemophilus Reference Unit in Oxford. We present the clinical features, management and complications of 40 cases of acute epiglottitis. H. influenzae was isolated from blood cultures in 28 cases (70%). In 12 of these cases, H. influenzae type b was identified, seven prior to 1993 and five thereafter. Four of these five cases presenting after introduction of the Hib vaccine were known to have been fully vaccinated. One child had a history of prematurity and serum immunoglobulin estimation was abnormally low in another child. Acute Hib

  8. Knowledge and use of evidence-based nutrition : a survey of paediatric dietitians

    NARCIS (Netherlands)

    Thomas, DE; Kukuruzovic, R; Martino, B; Chauhan, SS; Elliott, EJ

    2003-01-01

    Objective To survey paediatric dietitians' knowledge and use of evidence-based nutrition (EBN). Design Cross-sectional survey using reply-paid questionnaires. Subjects Paediatric dietitians in Australian teaching hospitals. Main outcome measures Age, sex, appointment, clinical practice, research

  9. Effect of Random Natural Fractures on Hydraulic Fracture Propagation Geometry in Fractured Carbonate Rocks

    Science.gov (United States)

    Liu, Zhiyuan; Wang, Shijie; Zhao, Haiyang; Wang, Lei; Li, Wei; Geng, Yudi; Tao, Shan; Zhang, Guangqing; Chen, Mian

    2018-02-01

    Natural fractures have a significant influence on the propagation geometry of hydraulic fractures in fractured reservoirs. True triaxial volumetric fracturing experiments, in which random natural fractures are created by placing cement blocks of different dimensions in a cuboid mold and filling the mold with additional cement to create the final test specimen, were used to study the factors that influence the hydraulic fracture propagation geometry. These factors include the presence of natural fractures around the wellbore, the dimension and volumetric density of random natural fractures and the horizontal differential stress. The results show that volumetric fractures preferentially formed when natural fractures occurred around the wellbore, the natural fractures are medium to long and have a volumetric density of 6-9%, and the stress difference is less than 11 MPa. The volumetric fracture geometries are mainly major multi-branch fractures with fracture networks or major multi-branch fractures (2-4 fractures). The angles between the major fractures and the maximum horizontal in situ stress are 30°-45°, and fracture networks are located at the intersections of major multi-branch fractures. Short natural fractures rarely led to the formation of fracture networks. Thus, the interaction between hydraulic fractures and short natural fractures has little engineering significance. The conclusions are important for field applications and for gaining a deeper understanding of the formation process of volumetric fractures.

  10. Role of MRI in hip fractures, including stress fractures, occult fractures, avulsion fractures

    International Nuclear Information System (INIS)

    Nachtrab, O.; Cassar-Pullicino, V.N.; Lalam, R.; Tins, B.; Tyrrell, P.N.M.; Singh, J.

    2012-01-01

    MR imaging plays a vital role in the diagnosis and management of hip fractures in all age groups, in a large spectrum of patient groups spanning the elderly and sporting population. It allows a confident exclusion of fracture, differentiation of bony from soft tissue injury and an early confident detection of fractures. There is a spectrum of MR findings which in part is dictated by the type and cause of the fracture which the radiologist needs to be familiar with. Judicious but prompt utilisation of MR in patients with suspected hip fractures has a positive therapeutic impact with healthcare cost benefits as well as social care benefits.

  11. [Treatment of multi-segment fracture of complex femoral shaft with instrument-assisted reduction combined with intramedullary interlocking nail fixation].

    Science.gov (United States)

    Fan, Ke-Jie; Chen, Ke; Ma, Wen-Long; Tian, Ke-Wei; Ye, Ye; Chen, Hong-Gan; Tang, Yan-Feng; Cai, Hong-Min

    2018-05-25

    To investigate the effect of minimally invasive mini-incision and instrumented reduction combined with interlocking intramedullary nailing in the treatment of patients with multi-segment fracture of complex femoral shaft. From January 2013 to January 2016, 32 patients with multiple fractures segments of femoral shaft were treated with instrumentation-assisted reduction combined with interlocking intramedullary nailing, including 22 males and 10 females with an average age of 45 years old ranging 17 to 68 years old. The time from injured to operation was 5 to 10 days with an average of 7 days. After admission, routine tibial tubercle or supracondylar bone traction was performed. The patient's general condition was evaluated, the operation time and intraoperative blood loss were recorded. According to Thorsen femoral fracture morphology evaluation criteria and Hohl knee function evaluation of postoperative efficacy, postoperative fracture healing, complications and postoperative recovery of limb function were observed. All patients were followed up for 6 to 24 months with an average of 12 months. The operative time ranged from 48 to 76 minutes with an average of 67 min. The intraoperative blood loss was 150 to 400 ml with an average of 220 ml. The surgical incisions all achieved grade A healing. The fractures reached the clinical standard of healing. The fracture healing time ranged from 4.2 to 10.8 months with an average of 5.7 months. There were no nonunion, incision infection and internal fixation fracture, failure and other complications. According to Thorsen femoral fracture morphology evaluation criteria, the result was excellent in 28 cases, good in 3 cases, fair in 1 case. According to Hohl knee function evaluation criteria, the result was excellent in 30 cases, good in 2 cases. Instrument-assisted reduction combined with interlocking intramedullary nail fixation is a safe and effective method for the treatment of complex femoral shaft fractures. It has

  12. Depression in paediatric chronic fatigue syndrome.

    Science.gov (United States)

    Bould, Helen; Collin, Simon M; Lewis, Glyn; Rimes, Katharine; Crawley, Esther

    2013-06-01

    To describe the prevalence of depression in children with chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME) and investigate the relationship between depression in CFS/ME and clinical symptoms such as fatigue, disability, pain and school attendance. Cross-sectional survey data using the Hospital Anxiety and Depression Scale (HADS) collected at assessment. Specialist paediatric CFS/ME service in the South West. Children aged 12-18 years with CFS/ME. Depression was defined as scoring >9 on the HADS depression scale. 542 subjects had complete data for the HADS and 29% (156/542) (95% CI 25% to 33%) had depression. In a univariable analysis, female sex, poorer school attendance, and higher levels of fatigue, disability, pain, and anxiety were associated with higher odds of depression. Age of child and duration of illness were not associated with depression. In a multivariable analysis, the factors most strongly associated with depression were disability, with higher scores on the physical function subscale of the 36 item Short Form (SF-36). Depression is commonly comorbid with CFS/ME, much more common than in the general population, and is associated with markers of disease severity. It is important to screen for, identify and treat depression in this population.

  13. Current practice in paediatric basic life support

    Directory of Open Access Journals (Sweden)

    Heczková Jana

    2017-06-01

    Full Text Available Introduction. Although the incidence of cardiac arrest in children is much lower than in adults, the condition is still considered a major health problem with a very low chance for survival. As in adults, the timely provision of cardiopulmonary resuscitation (CPR in children is crucial. Current guidelines for CPR in children were published along with the guidelines for CPR in adults in 2015. As in previous years, they are based on consensus provided by International Liaison Committee on Resuscitation (ILCOR. Guidelines of particular ILCOR member councils may vary and reflect regional characteristic such as different access to health care, education methods or willingness of population to provide emergency assistance. Moreover, the conditions requiring CPR in children are characterized not only by different incidence, but also by aetiology or techniques used for different age groups. Therefore, emphasis is put on simplicity and feasibility as well as on consistency with adult guidelines to improve retention of the paediatric sequences. Nurses may be first rescuers not only in health care facilities. Better understanding of CPR guidelines might help them to improve their ability to detect conditions requiring CRP and also initiate and provide effective emergency care.

  14. Radionuclide studies in paediatric nephro-urology

    Energy Technology Data Exchange (ETDEWEB)

    Piepsz, Amy E-mail: amypiepsz@yahoo.com

    2002-08-01

    The main tool of radionuclide techniques applied to paediatric uro-nephrology is the quantitation of function, which is an information not easily obtained by other diagnostic modalities. The radiation burden is low. Drug sedation is only rarely needed, whatever the age of the patient. Accurate determination of glomerular filtration rate can be obtained by means of an intravenous injection of Cr-51 EDTA and one or two blood samples. Tc-99m DMSA scintigraphy is an accurate method for evaluation of regional cortical impairment during acute pyelonephritis and later on, for detection of permanent scarring. Tc-99m MAG3 renography is nowadays a well-standardized method for accurate estimation of the split renal function and of renal drainage with or without furosemide challenge. This technique is particularly indicated in uni- or bilateral uropathies with or without renal and/or ureteral dilatation. Direct and indirect radionuclide cystography are two alternative modalities for X-ray MCUG. Their relative place in the strategy of management of vesicoureteral reflux is discussed.

  15. Paediatrics and psychoanalysis--Miss Anna Freud.

    Science.gov (United States)

    1983-01-01

    Miss Anna Freud died during the winter at the age of 86. She had been a pioneer in the understanding of children through psychoanalysis and a great champion of the rights of children. Her life began in Vienna as the youngest child of Sigmund Freud, and her early work with children was in Austria. In 1938, because of the Nazi régime and even though she was nursing her father during his terminal illness, she had to escape with him to London. Her work with homeless children and with those in residential nurseries in London during the second world war is well known, as is her work on child development and psychopathology in the postwar years. But one less well known aspect of her life that was of immense importance to a few fortunate British paediatricians was the 'paediatric group' that she ran for over a quarter of a century and which Dr Christine Cooper recalled at the memorial meeting in London earlier this year. PMID:6344806

  16. PAEDIATRIC OCULAR TRAUMA IN KUCHING, SARAWAK, MALAYSIA

    Directory of Open Access Journals (Sweden)

    INTAN G

    2011-01-01

    Full Text Available Purpose: To evaluate the demography, aetiology, type and outcome of paediatric ocular trauma in tertiary centre in Malaysia. Method: We retrospectively studied 118 eyes from 117 patients over a period of 36 months (January 2006 to December 2008. All ocular injuries in patients aged 12 and below seen in the Ophthalmology Department for the first time were included in thisstudy. Results: Mean age of patients was 6.1±3.0 years. 68 cases (58.2% occurred in pre-school children, whereas 49 (41.9% in school-aged children. Boys accounted for 65.8% of cases. There was no predilection for either right or the left eye. 47% of cases (56 patients occurred in Malay. Most of the injuries took place at home when the children were alone (p<0.05. Sharp objects were the commonest cause (45 cases, 38.1%. The majority of cases (103, 87.3% were considered preventable. The frequency of open and closed globe injury was similar. Hyphema was more common in closed globe injury compared to open globe injury (p<0.05. Other associated injuries such as cataract, vitreous hemorrhage and retinal hemorrhage are similar between the two groups. Visual outcome is generally poor with only 34 eyes (28.8% had no visual impairment. Conclusion: Ocular trauma in children is an important cause of visual loss. Most cases occurred at home and were preventable. Prevention through education is the best approach.

  17. Gait and Lower Limb Observation of Paediatrics (GALLOP): development of a consensus based paediatric podiatry and physiotherapy standardised recording proforma.

    Science.gov (United States)

    Cranage, Simone; Banwell, Helen; Williams, Cylie M

    2016-01-01

    Paediatric gait and lower limb assessments are frequently undertaken in podiatry and physiotherapy clinical practice and this is a growing area of expertise within Australia. No concise paediatric standardised recording proforma exists to assist clinicians in clinical practice. The aim of this study was to develop a gait and lower limb standardised recording proforma guided by the literature and consensus, for assessment of the paediatric foot and lower limb in children aged 0-18 years. Expert Australian podiatrists and physiotherapists were invited to participate in a three round Delphi survey panel using the online Qualtrics(©) survey platform. The first round of the survey consisted of open-ended questions on paediatric gait and lower limb assessment developed from existing templates and a literature search of standardised lower limb assessment methods. Rounds two and three consisted of statements developed from the first round responses. Questions and statements were included in the final proforma if 70 % or more of the participants indicated consensus or agreement with the assessment method and if there was support within the literature for paediatric age-specific normative data with acceptable reliability of outcome measures. There were 17 of the 21 (81 %) participants who completed three rounds of the survey. Consensus was achieved for 41 statements in Round one, 54 statements achieved agreement in two subsequent rounds. Participants agreed on 95 statements relating to birth history, developmental history, hip measurement, rotation of the lower limb, ankle range of motion, foot posture, balance and gait. Assessments with acceptable validity and reliability were included within the final Gait and Lower Limb Observation of Paediatrics (GALLOP) proforma. The GALLOP proforma is a consensus based, systematic and standardised way to collect information and outcome measures in paediatric lower limb assessment. This standardised recording proforma will assist

  18. Orbital fractures: a review

    Directory of Open Access Journals (Sweden)

    Jeffrey M Joseph

    2011-01-01

    Full Text Available Jeffrey M Joseph, Ioannis P GlavasDivision of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology, School of Medicine, New York University, New York, NY, USA; Manhattan Eye, Ear, and Throat Hospital, New York, NY, USAAbstract: This review of orbital fractures has three goals: 1 to understand the clinically relevant orbital anatomy with regard to periorbital trauma and orbital fractures, 2 to explain how to assess and examine a patient after periorbital trauma, and 3 to understand the medical and surgical management of orbital fractures. The article aims to summarize the evaluation and management of commonly encountered orbital fractures from the ophthalmologic perspective and to provide an overview for all practicing ophthalmologists and ophthalmologists in training.Keywords: orbit, trauma, fracture, orbital floor, medial wall, zygomatic, zygomatic complex, zmc fracture, zygomaticomaxillary complex fractures 

  19. Mechanics of Hydraulic Fractures

    Science.gov (United States)

    Detournay, Emmanuel

    2016-01-01

    Hydraulic fractures represent a particular class of tensile fractures that propagate in solid media under pre-existing compressive stresses as a result of internal pressurization by an injected viscous fluid. The main application of engineered hydraulic fractures is the stimulation of oil and gas wells to increase production. Several physical processes affect the propagation of these fractures, including the flow of viscous fluid, creation of solid surfaces, and leak-off of fracturing fluid. The interplay and the competition between these processes lead to multiple length scales and timescales in the system, which reveal the shifting influence of the far-field stress, viscous dissipation, fracture energy, and leak-off as the fracture propagates.

  20. Fracture in Soft Materials

    DEFF Research Database (Denmark)

    Hassager, Ole

    Fracture is a phenomenon that is generally associated with solids. A key element in fracture theory is the so-called weakest link idea that fracture initiates from the largest pre-existing material imperfection. However, recent work has demonstrated that fracture can also happen in liquids, where...... surface tension will act to suppress such imperfections. Therefore, the weakest link idea does not seem immediately applicable to fracture in liquids. This presentation will review fracture in liquids and argue that fracture in soft liquids is a material property independent of pre-existing imperfections....... The following questions then emerge: What is the material description needed to predict crack initiation, crack speed and crack shape in soft materials and liquids....

  1. Paediatric tracheostomy-An 11 year experience at a Scottish paediatric tertiary referral centre.

    Science.gov (United States)

    Douglas, C M; Poole-Cowley, J; Morrissey, S; Kubba, H; Clement, W A; Wynne, D

    2015-10-01

    The aim of this paper was to review the indications, complications and outcomes for tracheostomy at a Scottish paediatric tertiary referral hospital. All patients undergoing tracheostomy between January 2001 and September 2012 were identified. A retrospective case note analysis was performed. 111 tracheostomies were done in the study period. The mean number per year was 11 (3-12). Full data was available for 95 patients. There were 56 (59%) males and 39 (41%) females. Age at time of tracheostomy ranged from one day to 15 years, the mean age of tracheostomy insertion was 69 weeks. The majority of patients, 75 (79%), were under one year old when they had their tracheostomy. The most common indication was long-term ventilation (20%), followed by craniofacial abnormality causing airway obstruction (18%), followed by subglottic stenosis (14%). 37% of patients were decannulated. This series reflects current trends in the indications for paediatric tracheostomy, with chronic lung disease of prematurity being the most common indication. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  2. Finally in Italy the School of Specialisation in Paediatric Dentistry!

    Science.gov (United States)

    Marzo, G

    2017-06-01

    After over two decades of discussions, promises and indecisions, the year 2016 marked the birth of the School of Specialisation in Paediatric Dentistry, which is now a reality. The importance of dental post-graduate specialisation schools has been debated since the Degree Course in Dentistry was established. Previously, in Italy only two dental branches - Oral Surgery and Orthodontics - had obtained the recognition that a School of Specialisation entails. Today, with specific training and the newly- established hyper-specialisation in Paediatric Dentistry, the future of the profession is brighter than ever. This will allow dental professionals to provide the best cure to our young patients but it especially marks and recognises the importance of prevention in general. Having established a Specialty School in Paediatric Dentistry is also important to keep the pace with the other European countries where this postgraduate course has been already offered for many years. In my opinion, training professionals with a solid specialisation based both on cultural insights and hands-on clinical activities translates into the possibility of making true prevention. The ultimate goal of paediatric dentists, as well as paediatricians, is certainly to treat young patients but also and above all to accompany them toward an adulthood possibly free of pathologies. With an eye to a future where Paediatric Dentistry will be at the core of dental and orthodontic prevention, I wish great success to all the many specialisation schools established within the Italian Universities.

  3. Use of the Delphi process in paediatric cataract management.

    Science.gov (United States)

    Serafino, Massimiliano; Trivedi, Rupal H; Levin, Alex V; Wilson, M Edward; Nucci, Paolo; Lambert, Scott R; Nischal, Ken K; Plager, David A; Bremond-Gignac, Dominique; Kekunnaya, Ramesh; Nishina, Sachiko; Tehrani, Nasrin N; Ventura, Marcelo C

    2016-05-01

    To identify areas of consensus and disagreement in the management of paediatric cataract using a modified Delphi approach among individuals recognised for publishing in this field. A modified Delphi method. International paediatric cataract experts with a publishing record in paediatric cataract management. The process consisted of three rounds of anonymous electronic questionnaires followed by a face-to-face meeting, followed by a fourth anonymous electronic questionnaire. The executive committee created questions to be used for the electronic questionnaires. Questions were designed to have unit-based, multiple choice or true-false answers. The questionnaire included issues related to the preoperative, intraoperative and postoperative management of paediatric cataract. Consensus based on 85% of panellists being in agreement for electronic questionnaires or 80% for the face-to-face meeting, and near consensus based on 70%. Sixteen of 22 invited paediatric cataract surgeons agreed to participate. We arrived at consensus or near consensus for 85/108 (78.7%) questions and non-consensus for the remaining 23 (21.3%) questions. Those questions where consensus was not reached highlight areas of either poor evidence or contradicting evidence, and may help investigators identify possible research questions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  4. Peer mentoring: evaluation of a novel programme in paediatrics.

    Science.gov (United States)

    Eisen, Sarah; Sukhani, Seema; Brightwell, Alex; Stoneham, Sara; Long, Andrew

    2014-02-01

    Mentoring is important for personal and professional development of doctors. Peer mentoring is a core skill in the UK paediatric postgraduate curriculum. However, there is a paucity of peer mentoring programmes aimed at postgraduate doctors in training (postgraduate trainees), and there are no such schemes within paediatrics described in the literature. We developed a regional peer mentoring programme for postgraduate trainees in paediatrics to assess demand and need for peer mentoring and to explore the benefits for both peer mentees and mentors. Junior postgraduate trainees, randomly selected from volunteers, received peer mentoring from more senior trainees for 1 year. Peer mentors were selected by competitive application and undertook tailored training followed by an experiential learning programme. The programme was evaluated using structured questionnaires. 90% (76/84) of first-year postgraduate trainees in paediatrics applied to participate, demonstrating high demand. 18 peer mentor-mentee pairs were matched. Peer mentors and mentees reported high satisfaction rates, acquisition of new and transferable skills and changed behaviours. All peer mentors intended to use the skills in their workplace and, later, as an educational supervisor. Our programme represents a novel approach to meeting the demonstrated demand and the curriculum requirement for peer mentoring, and enabled peer mentors and mentees to develop a valuable and versatile skill set. To our knowledge, it is the first such programme in paediatrics and provides a feasibility model that may be adapted locally to allow education providers to offer this important experience to postgraduate trainees.

  5. Complementary and alternative medicine use among paediatric emergency department patients.

    Science.gov (United States)

    Taylor, David McDonald; Dhir, Reetika; Craig, Simon S; Lammers, Thalia; Gardiner, Kaya; Hunter, Kirrily; Joffe, Paul; Krieser, David; Babl, Franz E

    2015-09-01

    To determine the period prevalence and nature of complementary and alternative medicine (CAM) use among paediatric emergency department (ED) patients and the perceptions of CAM among the CAM administrators. A survey was undertaken in four Victorian EDs (January to September 2013). A convenience sample of parents/carers accompanying paediatric patients completed a self-administered questionnaire. The main outcome measures were CAM use and perceptions of CAM. The parents/carers of 883 patients participated. Three hundred eighty-eight (43.9%, 95% confidence interval (CI) 40.6-47.3) and 53 (6.0%, 95% CI 4.6-7.8) patients had taken a CAM within the previous 12 months and on the day of presentation, respectively. There were no gender differences between CAM users and non-users (P = 0.83). The use of CAM was significantly more common among older patients (P effective than prescription medicines and safe when taken with prescription medicines. CAM use is common among paediatric ED patients although rarely reported to the ED doctor. Parents/carers who administer CAM have differing perceptions of CAM safety from those who do not. © 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  6. Use of antibiotics in paediatric long-term care facilities.

    Science.gov (United States)

    Murray, M T; Johnson, C L; Cohen, B; Jackson, O; Jones, L K; Saiman, L; Larson, E L; Neu, N

    2018-06-01

    Adult long-term care (LTC) facilities have high rates of antibiotic use, raising concerns about antimicrobial resistance. Few studies have examined antibiotic use in paediatric LTC facilities. To describe antibiotic use in three paediatric LTC facilities and to describe the factors associated with use. A retrospective cohort study was conducted from September 2012 to December 2015 in three paediatric LTC facilities. Medical records were reviewed for demographics, healthcare-associated infections (HAIs), antimicrobial use and diagnostic testing. Logistic regression was used to identify predictors for antibiotic use. The association between susceptibility testing results and appropriate antibiotic coverage was determined using Chi-squared test. Fifty-eight percent (413/717) of residents had at least one HAI, and 79% (325/413) of these residents were treated with at least one antibiotic course, totalling 2.75 antibiotic courses per 1000 resident-days. Length of enrolment greater than one year, having a neurological disorder, having a tracheostomy, and being hospitalized at least once during the study period were significantly associated with receiving antibiotics when controlling for facility (all P facilities is widespread. There is further need to assess antibiotic use in paediatric LTC facilities. Evaluation of the adverse outcomes associated with inappropriate antibiotic use, including the prevalence of resistant organisms in paediatric LTC facilities, is critical. Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  7. Smartphone applications in paediatric radiology: availability and authority

    International Nuclear Information System (INIS)

    Shelmerdine, Susan C.; Lynch, Jeremy O.

    2015-01-01

    With the widespread ownership of smartphones, many health care professionals question the degree to which medically related smartphone applications are reliable. To assess the variety of smartphone applications relating to paediatric radiology and the presence of health care professional involvement in their development. As a secondary objective, we explore whether there are gaps within the paediatric radiology app market. The most popular smartphone marketplaces (Apple iTunes App Store, Blackberry Mobile Market, Google Play Android Market, Nokia Ovi, Samsung and Microsoft Windows Marketplace) were searched for terms relating to paediatric radiology. Cost, review ratings, number of downloads, health care involvement and target audience were recorded. Nine paediatric radiology applications were found in the Apple iTunes App Store and nine in the Google Play Android Market. The target audiences for all applications were health care professionals. None were available for patients or their caregivers. All applications were reported to have medical expertise in their development. All paediatric radiology applications were developed with the aid of a health care professional. Due to the small number available online, there is a potential gap in the marketplace for further applications in this field, possibly aimed at patients and their families. (orig.)

  8. Prebiotics as a modulator of gut microbiota in paediatric obesity.

    Science.gov (United States)

    Nicolucci, A C; Reimer, R A

    2017-08-01

    This review highlights our current understanding of the role of gut microbiota in paediatric obesity and the potential role for dietary manipulation of the gut microbiota with prebiotics in managing paediatric obesity. The aetiology of obesity is multifactorial and is now known to include microbial dysbiosis in the gut. Prebiotics are non-digestible carbohydrates which selectively modulate the number and/or composition of gut microbes. The goal of prebiotic consumption is to restore symbiosis and thereby confer health benefits to the host. There is convincing evidence that prebiotics can reduce adiposity and improve metabolic health in preclinical rodent models. Furthermore, there are several clinical trials in adult humans highlighting metabolic and appetite-regulating benefits of prebiotics. In paediatric obesity, however, there are very limited data regarding the potential role of prebiotics as a dietary intervention for obesity management. As the prevalence of paediatric obesity and obesity-associated comorbidities increases globally, interventions that target the progression of obesity from an early age are essential in slowing the obesity epidemic. This review emphasizes the need for further research assessing the role of prebiotics, particularly as an intervention in effectively managing paediatric obesity. © 2016 World Obesity Federation.

  9. Smartphone applications in paediatric radiology: availability and authority

    Energy Technology Data Exchange (ETDEWEB)

    Shelmerdine, Susan C. [Great Ormond Street Hospital, Specialist Registrar in Clinical Radiology, Department of Clinical Radiology, London (United Kingdom); Lynch, Jeremy O. [Chelsea and Westminster Hospital, Specialist Registrar in Clinical Radiology, Department of Clinical Radiology, London (United Kingdom)

    2015-08-15

    With the widespread ownership of smartphones, many health care professionals question the degree to which medically related smartphone applications are reliable. To assess the variety of smartphone applications relating to paediatric radiology and the presence of health care professional involvement in their development. As a secondary objective, we explore whether there are gaps within the paediatric radiology app market. The most popular smartphone marketplaces (Apple iTunes App Store, Blackberry Mobile Market, Google Play Android Market, Nokia Ovi, Samsung and Microsoft Windows Marketplace) were searched for terms relating to paediatric radiology. Cost, review ratings, number of downloads, health care involvement and target audience were recorded. Nine paediatric radiology applications were found in the Apple iTunes App Store and nine in the Google Play Android Market. The target audiences for all applications were health care professionals. None were available for patients or their caregivers. All applications were reported to have medical expertise in their development. All paediatric radiology applications were developed with the aid of a health care professional. Due to the small number available online, there is a potential gap in the marketplace for further applications in this field, possibly aimed at patients and their families. (orig.)

  10. Hidden Costs in Paediatric Psychiatry Consultation Liaison Services

    LENUS (Irish Health Repository)

    Kehoe, C

    2018-03-01

    It is recognised that children attending paediatric services have an increased rate of mental health (MH) problems1. Hospital based Mental Health services, interchangeably termed Psychiatric Consultation Liaison Services (PCLS), or Psychological Medicine, exist in the large hospitals, and collaborate with their paediatric colleagues, offering assessment and intervention as required. However, PCLS may also have a role in providing Emergency MH assessments for young people presenting to the Emergency Department (ED), a role independent of their paediatric colleagues. In some cases, these children will need to be admitted to an acute paediatric bed for the management of their mental health illness or psychological distress, awaiting transfer to a child psychiatry specialised bed, or discharge to community services. The profile and costs of these cases are inadequately captured by both HSE CAMHS Annual Reporting System3,4 and the Healthcare Pricing Office (HIPE)2 as they often inadequately record MH referrals. This study explores the costs associated with a cohort of patients presenting to a large paediatric hospital ED, and managed by PCLS, in a one-year period.

  11. The use of the Statscan digital X-ray unit in paediatric polytrauma

    Energy Technology Data Exchange (ETDEWEB)

    Pitcher, Richard D. [University of Cape Town, Division of Paediatric Radiology, Red Cross War Memorial Children' s Hospital, School of Child and Adolescent Health, Cape Town (South Africa); Wilde, Jim C.H. [University of Cape Town, Division of Paediatric Surgery, Red Cross War Memorial Children' s Hospital, School of Child and Adolescent Health, Cape Town (South Africa); University of Amsterdam, Paediatric Surgical Centre of Amsterdam, Emma Children' s Hospital, Academic Medical Centre, Amsterdam (Netherlands); Douglas, Tania S. [University of Cape Town, MRC/UCT Medical Imaging Research Unit, Department of Human Biology, Cape Town (South Africa); As, Arjan Bastiaan van [University of Cape Town, Division of Paediatric Surgery, Red Cross War Memorial Children' s Hospital, School of Child and Adolescent Health, Cape Town (South Africa)

    2009-05-15

    We present a 3-year review of clinical paediatric experience with the statscan (Lodox Systems, Johannesburg, South Africa), a low-dose, digital, whole-body, slit-scanning X-ray machine. While focusing on the role of the unit in paediatric polytrauma, insight into its applications in other paediatric settings is provided. (orig.)

  12. The use of the Statscan digital X-ray unit in paediatric polytrauma

    International Nuclear Information System (INIS)

    Pitcher, Richard D.; Wilde, Jim C.H.; Douglas, Tania S.; As, Arjan Bastiaan van

    2009-01-01

    We present a 3-year review of clinical paediatric experience with the statscan (Lodox Systems, Johannesburg, South Africa), a low-dose, digital, whole-body, slit-scanning X-ray machine. While focusing on the role of the unit in paediatric polytrauma, insight into its applications in other paediatric settings is provided. (orig.)

  13. Paediatric cardiopulmonary resuscitation training program in Latin-America: the RIBEPCI experience.

    Science.gov (United States)

    López-Herce, Jesús; Matamoros, Martha M; Moya, Luis; Almonte, Enma; Coronel, Diana; Urbano, Javier; Carrillo, Ángel; Del Castillo, Jimena; Mencía, Santiago; Moral, Ramón; Ordoñez, Flora; Sánchez, Carlos; Lagos, Lina; Johnson, María; Mendoza, Ovidio; Rodriguez, Sandra

    2017-09-12

    To describe the design and to present the results of a paediatric and neonatal cardiopulmonary resuscitation (CPR) training program adapted to Latin-America. A paediatric CPR coordinated training project was set up in several Latin-American countries with the instructional and scientific support of the Spanish Group for Paediatric and Neonatal CPR. The program was divided into four phases: CPR training and preparation of instructors; training for instructors; supervised teaching; and independent teaching. Instructors from each country participated in the development of the next group in the following country. Paediatric Basic Life Support (BLS), Paediatric Intermediate (ILS) and Paediatric Advanced (ALS) courses were organized in each country adapted to local characteristics. Five Paediatric Resuscitation groups were created sequentially in Honduras (2), Guatemala, Dominican Republican and Mexico. During 5 years, 6 instructors courses (94 students), 64 Paediatric BLS Courses (1409 students), 29 Paediatrics ILS courses (626 students) and 89 Paediatric ALS courses (1804 students) were given. At the end of the program all five groups are autonomous and organize their own instructor courses. Training of autonomous Paediatric CPR groups with the collaboration and scientific assessment of an expert group is a good model program to develop Paediatric CPR training in low- and middle income countries. Participation of groups of different countries in the educational activities is an important method to establish a cooperation network.

  14. A day in the life of a paediatric surgeon: a PAPSA research study ...

    African Journals Online (AJOL)

    Objectives This study aimed to create a snapshot picture of the global workload of paediatric surgeons and identify differences between countries. Methods Surgeons from 13 paediatric surgical units in different countries across the world were asked to record the number and type of admissions to the paediatric surgery ...

  15. Clinical efficacy of open reduction and semirigid internal fixation in management of displaced pediatric mandibular fractures: A series of 10 cases and surgical guidelines

    Directory of Open Access Journals (Sweden)

    Samir Joshi

    2015-01-01

    Full Text Available Aim: To evaluate the efficacy of open reduction and semirigid internal fixation in the management of displaced pediatric mandibular fractures. Method: Ten patients with displaced mandibular fractures treated with 1.5 mm four holed titanium mini-plate and 4 mm screws which were removed within four month after surgery. Results: All cases showed satisfactory bone healing without any growth disturbance. Conclusion: Open reduction and rigid internal fixation (ORIF with 1.5 mm titanium mini- plates and 4 mm screws is a reliable and safe method in treatment of displaced paediatric mandibular fractures.

  16. Clinical efficacy of open reduction and semirigid internal fixation in management of displaced pediatric mandibular fractures: a series of 10 cases and surgical guidelines.

    Science.gov (United States)

    Joshi, Samir; Kshirsagar, Rajesh; Mishra, Akshay; Shah, Rahul

    2015-01-01

    To evaluate the efficacy of open reduction and semirigid internal fixation in the management of displaced pediatric mandibular fractures. Ten patients with displaced mandibular fractures treated with 1.5 mm four holed titanium mini-plate and 4 mm screws which were removed within four month after surgery. All cases showed satisfactory bone healing without any growth disturbance. Open reduction and rigid internal fixation (ORIF) with 1.5 mm titanium mini- plates and 4 mm screws is a reliable and safe method in treatment of displaced paediatric mandibular fractures.

  17. Biomechanical properties of orthogonal plate configuration versus parallel plate configuration using the same locking plate system for intra-articular distal humeral fractures under radial or ulnar column axial load.

    Science.gov (United States)

    Kudo, Toshiya; Hara, Akira; Iwase, Hideaki; Ichihara, Satoshi; Nagao, Masashi; Maruyama, Yuichiro; Kaneko, Kazuo

    2016-10-01

    Previous reports have questioned whether an orthogonal or parallel configuration is superior for distal humeral articular fractures. In previous clinical and biomechanical studies, implant failure of the posterolateral plate has been reported with orthogonal configurations; however, the reason for screw loosening in the posterolateral plate is unclear. The purpose of this study was to evaluate biomechanical properties and to clarify the causes of posterolateral plate loosening using a humeral fracture model under axial compression on the radial or ulnar column separately. And we changed only the plate set up: parallel or orthogonal. We used artificial bone to create an Association for the Study of Internal Fixation type 13-C2.3 intra-articular fracture model with a 1-cm supracondylar gap. We used an anatomically-preshaped distal humerus locking compression plate system (Synthes GmbH, Solothurn, Switzerland). Although this is originally an orthogonal plate system, we designed a mediolateral parallel configuration to use the contralateral medial plate instead of the posterolateral plate in the system. We calculated the stiffness of the radial and ulnar columns and anterior movement of the condylar fragment in the lateral view. The parallel configuration was superior to the orthogonal configuration regarding the stiffness of the radial column axial compression. There were significant differences between the two configurations regarding anterior movement of the capitellum during axial loading of the radial column. The posterolateral plate tended to bend anteriorly under axial compression compared with the medial or lateral plate. We believe that in the orthogonal configuration axial compression induced more anterior displacement of the capitellum than the trochlea, which eventually induced secondary fragment or screw dislocation on the posterolateral plate, or nonunion at the supracondylar level. In the parallel configuration, anterior movement of the capitellum or

  18. Diagnosis of vertebral fractures in children: is a simplified algorithm-based qualitative technique reliable?

    International Nuclear Information System (INIS)

    Adiotomre, E.; Summers, L.; Digby, M.; Allison, A.; Walters, S.J.; Broadley, P.; Lang, I.; Offiah, A.C.

    2016-01-01

    Identification of osteoporotic vertebral fractures allows treatment opportunity reducing future risk. There is no agreed standardised method for diagnosing paediatric vertebral fractures. To evaluate the precision of a modified adult algorithm-based qualitative (ABQ) technique, applicable to children with primary or secondary osteoporosis. Three radiologists independently assessed lateral spine radiographs of 50 children with suspected reduction in bone mineral density using a modified ABQ scoring system and following simplification to include only clinically relevant parameters, a simplified ABQ score. A final consensus of all observers using simplified ABQ was performed as a reference standard for fracture characterisation. Kappa was calculated for interobserver agreement of the components of both scoring systems and intraobserver agreement of simplified ABQ based on a second read of 29 randomly selected images. Interobserver Kappa for modified ABQ scoring for fracture detection, severity and shape ranged from 0.34 to 0.49 Kappa for abnormal endplate and position assessment was 0.27 to 0.38. Inter- and intraobserver Kappa for simplified ABQ scoring for fracture detection and grade ranged from 0.37 to 0.46 and 0.45 to 0.56, respectively. Inter- and intraobserver Kappa for affected endplate ranged from 0.31 to 0.41 and 0.45 to 0.51, respectively. Subjectively, observers' felt simplified ABQ was easier and less time-consuming. Observer reliability of modified and simplified ABQ was similar, with slight to moderate agreement for fracture detection and grade/severity. Due to subjective preference for simplified ABQ, we suggest its use as a semi-objective measure of diagnosing paediatric vertebral fractures. (orig.)

  19. Diagnosis of vertebral fractures in children: is a simplified algorithm-based qualitative technique reliable?

    Energy Technology Data Exchange (ETDEWEB)

    Adiotomre, E. [Sheffield Teaching Hospitals NHS Foundation Trust UK, Radiology Department, Sheffield (United Kingdom); Sheffield Children' s NHS Foundation Trust, Radiology Department, Sheffield (United Kingdom); Summers, L.; Digby, M. [University of Sheffield UK, Sheffield Medical School, Sheffield (United Kingdom); Allison, A.; Walters, S.J. [University of Sheffield UK, School of Health and Related Research, Sheffield (United Kingdom); Broadley, P.; Lang, I. [Sheffield Children' s NHS Foundation Trust, Radiology Department, Sheffield (United Kingdom); Offiah, A.C. [Sheffield Children' s NHS Foundation Trust, Radiology Department, Sheffield (United Kingdom); University of Sheffield UK, Academic Unit of Child Health, Sheffield (United Kingdom)

    2016-05-15

    Identification of osteoporotic vertebral fractures allows treatment opportunity reducing future risk. There is no agreed standardised method for diagnosing paediatric vertebral fractures. To evaluate the precision of a modified adult algorithm-based qualitative (ABQ) technique, applicable to children with primary or secondary osteoporosis. Three radiologists independently assessed lateral spine radiographs of 50 children with suspected reduction in bone mineral density using a modified ABQ scoring system and following simplification to include only clinically relevant parameters, a simplified ABQ score. A final consensus of all observers using simplified ABQ was performed as a reference standard for fracture characterisation. Kappa was calculated for interobserver agreement of the components of both scoring systems and intraobserver agreement of simplified ABQ based on a second read of 29 randomly selected images. Interobserver Kappa for modified ABQ scoring for fracture detection, severity and shape ranged from 0.34 to 0.49 Kappa for abnormal endplate and position assessment was 0.27 to 0.38. Inter- and intraobserver Kappa for simplified ABQ scoring for fracture detection and grade ranged from 0.37 to 0.46 and 0.45 to 0.56, respectively. Inter- and intraobserver Kappa for affected endplate ranged from 0.31 to 0.41 and 0.45 to 0.51, respectively. Subjectively, observers' felt simplified ABQ was easier and less time-consuming. Observer reliability of modified and simplified ABQ was similar, with slight to moderate agreement for fracture detection and grade/severity. Due to subjective preference for simplified ABQ, we suggest its use as a semi-objective measure of diagnosing paediatric vertebral fractures. (orig.)

  20. Quality of outpatient paediatric chest radiography - a pilot study

    International Nuclear Information System (INIS)

    Engelmann, D.; Duetting, T.; Wunsch, R.; Troeger, J.

    2001-01-01

    A quality control of outpatient paediatric chest X-rays was conducted in a sample of patients of one paediatric practice. During a period of eight months the technical image quality was analysed considering both diagnostic aspects and radiation protection. The quality of the 139 examined chest X-rays was inadequate concerning the collimation and focussing of the X-rays and the positioning of the patients. Exposure was estimated as average, sharpness was rated as good. In total 14% of the X-rays were not suitable for medical diagnosis. Image quality of the X-rays of infants (children younger than 6 years) was significantly lower compared to the total sample. Radiation protection standards were not fulfilled. As a conclusion from our results, improvements in outpatient paediatric radiography are urgently necessary. Quality control committees should pay particular attention in radiographs of infants. (orig.) [de

  1. Use of complementary/alternative medicine among paediatric patients

    DEFF Research Database (Denmark)

    Madsen, Hanne; Andersen, Susie; Nielsen, Rasmus Gaardskaer

    2003-01-01

    Hospital during a 2 week period in the autumn of 2001 were asked to participate. In total, 622 (92%) patients participated. The data were collected in an interviewer administered questionnaire during a short structured interview with the patient and parents. CAM was divided into herbal medicine (herbal......UNLABELLED: The use of complementary/alternative medicine (CAM) is increasing. The aim was to characterise the use of CAM among patients in a paediatric department. All patients (aged 0-18 years), out-patients or hospitalised, in contact with the Department of Paediatrics, Odense University...... patients suffering from gastrointestinal diseases or hospitalised for observation. More than 50% of the users experienced positive effects and 6% had side-effects from AM. Of the CAM users, 11% or 2% of the total paediatric population used CAM instead of conventional medicines. CONCLUSION...

  2. Paediatric Pain Management: Using Complementary and Alternative Medicine.

    Science.gov (United States)

    Evans, Subhadra; Tsao, Jennie C I; Zeltzer, Lonnie K

    2008-09-01

    Children undergo acute painful procedures and many also experience chronic pain.Due to their developing systems, infants and children may be at greater risk than adults for protracted pain sensitivity.There is a need to manage acute and chronic paediatric pain to reduce children's suffering and to prevent future pain problems.Consistent with a biopsychosocial perspective, complementary and alternative medicine (CAM) should be considered in management of acute and chronic paediatric pain.Although research is limited for paediatric pain, CAM interventions receiving the most empirical attention include hypnotherapy, acupuncture and music therapy. Evidence also exists for the therapeutic benefits of yoga, massage, humor therapy and the use of certain biological based therapies.

  3. Review of simulation in paediatrics: The evolution of a revolution

    Directory of Open Access Journals (Sweden)

    Rahul eOjha

    2015-11-01

    Full Text Available Recent changes in medical education have highlighted the importance of experiential learning. Simulation is one model that has gained significant attention in the last decade and has been widely adopted as a training and assessment tool in medical education. Paediatric simulation has been utilized to teach various skills including resuscitation and trauma management, procedural skills and team training. It is also a valuable tool for health care educators, as it allows learners to achieve competence without putting patients at risk. Recent literature demonstrates increased retention of knowledge and skills after simulation based training. Further research is required to improve current simulation curriculums, develop validated assessment tools and to demonstrate improved clinical outcomes after simulation based training. We conducted an online search of original and review articles related to simulation and paediatric medical education and provide an overview of the role and utility of simulation in paediatrics.

  4. Ballistic fractures: indirect fracture to bone.

    Science.gov (United States)

    Dougherty, Paul J; Sherman, Don; Dau, Nathan; Bir, Cynthia

    2011-11-01

    Two mechanisms of injury, the temporary cavity and the sonic wave, have been proposed to produce indirect fractures as a projectile passes nearby in tissue. The purpose of this study is to evaluate the temporal relationship of pressure waves using strain gauge technology and high-speed video to elucidate whether the sonic wave, the temporary cavity, or both are responsible for the formation of indirect fractures. Twenty-eight fresh frozen cadaveric diaphyseal tibia (2) and femurs (26) were implanted into ordnance gelatin blocks. Shots were fired using 9- and 5.56-mm bullets traversing through the gelatin only, passing close to the edge of the bone, but not touching, to produce an indirect fracture. High-speed video of the impact event was collected at 20,000 frames/s. Acquisition of the strain data were synchronized with the video at 20,000 Hz. The exact time of fracture was determined by analyzing and comparing the strain gauge output and video. Twenty-eight shots were fired, 2 with 9-mm bullets and 26 with 5.56-mm bullets. Eight indirect fractures that occurred were of a simple (oblique or wedge) pattern. Comparison of the average distance of the projectile from the bone was 9.68 mm (range, 3-20 mm) for fractured specimens and 15.15 mm (range, 7-28 mm) for nonfractured specimens (Student's t test, p = 0.036). In this study, indirect fractures were produced after passage of the projectile. Thus, the temporary cavity, not the sonic wave, was responsible for the indirect fractures.

  5. Collaboration between paediatric surgery and other medical specialties in Nigeria

    Directory of Open Access Journals (Sweden)

    Philemon E Okoro

    2012-01-01

    Full Text Available Background: The quality of service and success of patient care and research in most fields of medicine depend on effective collaboration between different specialties. Paediatric surgery is a relatively young specialty in Nigeria and such collaborations are desirable. This survey assesses the nature and extent of collaboration between paediatric surgery and other specialties in Nigeria. Materials and Methods: This is a questionnaire survey carried out in November 2008 among paediatric surgeons and their trainees practising in Nigeria. Questionnaires were distributed and retrieved either by hand or e-mailing. The responses were then collated and analysed using the SPSS 17.0. Results: Forty-seven respondents were included in the survey. Forty-five (95.7% respondents thought that there was inadequate collaboration and that there was a need for an increased collaboration between paediatric surgery and other specialties. Anaesthesia, paediatrics and radiology are among the specialties where collaborations were most required but not adequately received. Collaboration had been required from these specialties in areas of patient care, training and research. Reasons for inadequate collaboration included the paucity of avenues for inter-specialty communication and exchange of ideas 33 (70.3%, lack of awareness of the need for collaboration 32 (68.1%, tendency to apportion blames for bad outcome 13 (27.7%, and mutual suspicion 8 (17%. Conclusion: There is presently inadequate collaboration between paediatric surgery and other specialties in Nigeria. There is a need for more inter-specialty support, communication, and exchange of ideas in order to achieve desirable outcomes.

  6. Participation in paediatric perioperative care: 'what it means for parents'.

    Science.gov (United States)

    Sjöberg, Carina; Svedberg, Petra; Nygren, Jens M; Carlsson, Ing-Marie

    2017-12-01

    To explore what it means for parents to participate in their children's paediatric perioperative care. Allowing parents to participate in paediatric perioperative care can make a major difference for children in terms of their well-being, a decreased need for painkillers, fewer sleeping disorders and a more positive experience for both parties. The nurse anaesthetist should have a holistic view and develop a shared vision for the child, the parents and for themselves to perform successful paediatric perioperative care. Descriptive qualitative study. The study was conducted in 2014. Data were collected in 20 narrative interviews with 15 mothers and five fathers who had experience of participating in their child's paediatric perioperative day surgery. The analysis was carried out with qualitative content analysis to describe the variations, differences and similarities in the experiences. The analysis revealed a main category that describes that parental participation in the context of paediatric perioperative care in day surgery meant 'having strength to participate despite an increased vulnerability'. Three generic categories with additional subcategories explained what was essential for the parents to be able to preserve this strength and participate in their child's care despite their increased vulnerability. The generic categories were named, 'gaining information about what will happen', 'being seen as a resource' and 'gaining access to the environment'. Efforts should be made to improve parents' roles and opportunities to participate in paediatric perioperative care. Nurse anaesthetists have a crucial role in enabling parents' participation and need knowledge to develop strategies and nursing interventions that meet parents' needs. © 2017 John Wiley & Sons Ltd.

  7. Impact of child death on paediatric trainees.

    Science.gov (United States)

    Hollingsworth, Clare E; Wesley, Carla; Huckridge, Jaymie; Finn, Gabrielle M; Griksaitis, Michael J

    2018-01-01

    To assess the prevalence of symptoms of acute stress reactions (ASR) and post-traumatic stress disorder (PTSD) in paediatric trainees following their involvement in child death. A survey designed to identify trainees' previous experiences of child death combined with questions to identify features of PTSD. Quantitative interpretation was used alongside a χ 2 test. A p value of death of a child, although 190/284 (67%) had no training in child death. 118/248 (48%) of trainees were given a formal debrief session following their most recent experience. 203/251 (81%) of trainees reported one or more symptoms or behaviours that could contribute to a diagnosis of ASR/PTSD. 23/251 (9%) of trainees met the complete criteria for ASR and 13/251 (5%) for PTSD. Attending a formal debrief and reporting feelings of guilt were associated with an increase in diagnostic criteria for ASR/PTSD (p=0.036 and pdeath of a child. The feeling of guilt should be identified and acknowledged to allow prompt signposting to further support, including psychological assessment or intervention if required. Clear recommendations need to be made about the safety of debriefing sessions as, in keeping with existing evidence, our data suggest that debrief after the death of a child may be associated with the development of symptoms suggestive of ASR/PTSD. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  8. Assessment of paediatric hydronephrosis using output efficiency

    International Nuclear Information System (INIS)

    Saundres, C.A.B.; Choong, K.K.L.; Gruenewald, S.M.

    1998-01-01

    Full text: Diuretic renography is an important tool in the evaluation of paediatric hydronephrosis. Recently a newly developed parameter, output efficiency (OE) has allowed normalisation of washout according to renal function. We retrospectively reviewed the diagnostic accuracy of OE in 56 children (70 hydronephrotic kidneys). There were 16 females and 41 males (mean age 1.4 years, range 3 weeks-12 years). Diuretic renography ( 99m Tc-MAG3) was performed using i.v. volume expansion (15 mL/kg), frusemide diuresis (1mg/kg) and urethral catheterisation if VUR was present. Final diagnosis was made using surgery (n = 15) or clinical outcome (n = 42). Clinical follow up exceeded one year and included repeat MAG3 scan (n = 20), resolving hydronephrosis on ultrasound (n = 15) or percutaneous antegrade pyelogram (n = 1). Initial scans were classified as obstructed (n 13), indeterminate (n = 13) or non obstructed (n = 30) based on standard qualitative and quantitative criteria. Using a normal range of >84%, OE correctly predicted 12/13 (92%) obstructed kidneys and 44/44 non-obstructed kidneys (100%). In the indeterminate group, three kidneys developed obstruction at follow -up and 10 became non obstructed. Initial OE predicted outcome in two and four kidneys respectively. Overall, OE sensitivity and specificity were 88% and 89%. In the subgroup of patients (n = 19) with reduced differential function (<40%) the sensitivity of OE was 100% and specificity was 75%. This compares to 83% and 66% for Tl/2 in this subgroup. Therefore OE is a useful marker of renal outflow tract obstruction and maybe superior to other parameters such as Tl/2 particularly when renal function is reduced

  9. Treatment of pediatric femoral shaft fractures by stainless steel and titanium elastic nail system: A randomized comparative trial

    Directory of Open Access Journals (Sweden)

    Tank Gyaneshwar

    2016-08-01

    Conclusion: Majority of paediatric femoral shaft fractures are now treated operatively by elastic stable intramedullary nails. Operative intervention results in a shorter hospital stay and has economic and social benefits over conservative treatment. The cost of stainless steel nail is one third the cost of titanium nail. However, the clinico-radiological results are not significantly different between titanium and stainless steel nails at one year follow-up as observed by our study.

  10. Radiographic appearances of uncommon paediatric implants and devices

    Energy Technology Data Exchange (ETDEWEB)

    Urquia, Arlen; Watson, Tom A.; Arthurs, Owen J. [Great Ormond Street Hospital NHS Foundation Trust, Department of Radiology, London (United Kingdom)

    2015-06-15

    As childhood survival of chronic illness improves, long-term implanted devices will be encountered more frequently in routine radiology. In our paediatric tertiary referral hospital, we have come across several types of implanted devices that were not confidently recognised or identified by front-line staff and were often only identified by discussion with the patient, family or clinical team. This pictorial review highlights the appearance of nonvascular devices on paediatric radiographs in order to help clinicians identify the most frequent complications and to improve awareness of these important devices. (orig.)

  11. Paediatric oncology in the developing world: an African perspective.

    Science.gov (United States)

    Nkrumah, F K

    1987-09-01

    Nutritional deficiency and infectious diseases constitute major paediatric priorities in most developing countries in Africa today. It is suggested that successful implementation of the various cost-effective intervention programmes which address themselves to these priorities will gradually unveil other paediatric problems presently considered of low priority. These will include the malignant diseases of childhood. The very high cost of cancer detection and treatment will demand carefully reasoned and planned approaches in most Third World countries. The implications of this in relation to childhood malignancies in Africa are discussed.

  12. MRI of the marrow in the paediatric skeleton

    International Nuclear Information System (INIS)

    Foster, K.; Chapman, S.; Johnson, K.

    2004-01-01

    Magnetic resonance imaging (MRI) has greatly advanced evaluation of marrow diseases of the paediatric skeleton. As with many other aspects of paediatric radiology it is important to recognize the normal variations in the appearance of the marrow that occur in the growing child. These normal variations need to be differentiated from diseases and conditions that affect the marrow. This review describes the normal changes that occur in children with age, and the appearances of the pathological changes seen in infection, infiltration, haematological disorders, transplantation and radiation therapy

  13. Paediatric ultrasonography of the liver, hepatobiliary tract and pancreas

    Energy Technology Data Exchange (ETDEWEB)

    Rijn, R.R. van, E-mail: r.r.vanrijn@amc.uva.nl [Department of Radiology, Emma Children' s Hospital – Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam (Netherlands); Nievelstein, R.A.J. [Department of Radiology, Wilhelmina Children' s Hospital – University Medical Center, Heidelberglaan 100, 3584 CX Utrecht (Netherlands)

    2014-09-15

    In the field of paediatric radiology ultrasonography (US) is the most versatile imaging tool available. Children in general, by virtue of their body composition, are excellent candidates for US exams in whom abdominal anatomy and pathology can be visualised in great detail. The fact that during the US study a clinical history can be obtained strongly adds to the value of the US exam. This does require investment in time and expertise and ideally a paediatric radiologist performing the exam. In this review the role of ultrasonography (US) of the liver, biliary tract and pancreas in children is discussed.

  14. Paediatric trauma imaging: Why do we need separate guidance?

    International Nuclear Information System (INIS)

    Negus, S.; Danin, J.; Fisher, R.; Johnson, K.; Landes, C.; Somers, J.; Fitzsimmons, C.; Ashford, N.; Foster, J.

    2014-01-01

    It is often assumed that the pattern of injury in children mirrors that of the adult population, but children have different anatomical proportions and the relative elasticity of their tissues results in different injury patterns. The authors of this review are members of the British Society of Paediatric Radiologists subgroup and developed the recently published 47 paediatric trauma protocols for imaging children involved in major blunt trauma. The following article has been written to bring these guidelines to the attention of the wider community of UK radiologists, and explain the rationale behind the recommendations

  15. The Swiss regulatory framework for paediatric health research.

    Science.gov (United States)

    Junod, Valerie

    2008-07-01

    Medical research on minors entails both risks and benefits. Under Swiss law, clinical trials on children, including nontherapeutic drug trials, are permissible. However, ethics committees must systematically verify that all clinical studies have a favorable risk-benefit profile. Additional safeguards are designed to ensure that children are not unnecessarily involved in research and that proper consent is always obtained. Federal Swiss law is undergoing revision to extend these protections beyond clinical trials to a broad array of health research. The Swiss drug agency also seeks to improve the incentives for pharmaceutical firms to develop new paediatric drugs and relevant paediatric drug labels.

  16. Locking plate and fibular strut-graft augmentation in the reconstruction of unicameral bone cyst of proximal femur in the paediatric population.

    Science.gov (United States)

    Jamshidi, Khodamorad; Mirkazemi, Masoud; Izanloo, Azra; Mirzaei, Alireza

    2018-01-01

    Several therapeutic strategies have been used for managing unicameral bone cyst (UBC) of the proximal femur. However, there is insufficient evidence to support one treatment over another, and the optimal treatment is controversial. This study aims at describing our experience with surgical reconstruction of paediatric UBCs of the proximal femur using a proximal locking plate and fibular strut allograft. In total, 14 consecutive paediatric patients with Dormans types IB (four cases) and IIB (10 cases) UBC were assessed. Mean patient age was 8.6 ± 2.3 years, and mean follow-up period was 41.7 ± 29.8 months. Six patients (42.8%) were referred with a pathologic fracture. Clinical/radiological outcome and complication rates were evaluated at the final follow-up session. No cysts were Capanna's class III (recurrence) or IV (no response). Complete healing (Capanna's class I) was seen in ten cysts, while four other cysts healed with residual radiolucent areas (Capanna's class II). Mean healing period was 14.1 ± 5.1 (9-24 months). One patient had superficial infection, one heterotopic ossification, and one mild coxa vara, and mean Musculoskeletal Tumor Society (MSTS) score was 99.5%. According to our results, locking plate and fibular strut graft in Dormans classification types IB and IIB results in a favorable outcome in managing UBC of the proximal femur in the paediatric population.

  17. Paediatric injury from indoor trampoline centres.

    Science.gov (United States)

    Mulligan, Christopher S; Adams, Susan; Brown, Julie

    2017-10-01

    Indoor trampoline parks are increasing as a source of injuries among children. We conducted a prospective cohort study, with semi-structured interview and medical record review, of children aged trampoline park. In a 6-month period in 2014, 40 such children (55% female) presented to the department. Common mechanisms were individual jumpers falling while attempting a somersault or trick, landing awkwardly on an obstacle such as a ball or protective padding, and multiple users on a single trampoline. Most sustained soft tissue injuries (n=22, 55%) and fractured bones (n=15, 37.5%). One child sustained an unstable cervical fracture/dislocation. Unlike domestic trampolines, where the majority of injuries occur from falling off, most trampoline-park injuries occur on the trampoline surface. These differences require injury prevention strategies that engage children, carers and businesses to meet best practice design and management standards. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  18. Atraumatic First Rib Fracture

    Directory of Open Access Journals (Sweden)

    Koray Aydogdu

    2014-12-01

    Full Text Available Rib fractures are usually seen after a trauma, while atraumatic spontaneous rib fractures are quite rare. A first rib fracture identified in our 17 years old female patient who had not a history of trauma except lifting a heavy weight was examined in details in terms of the potential complications and followed-up for a long time. We presented our experience on this case with atraumatic first rib fracture that has different views for the etiology in light of the literature.

  19. Fracture mechanics safety approaches

    International Nuclear Information System (INIS)

    Roos, E.; Schuler, X.; Eisele, U.

    2004-01-01

    Component integrity assessments require the knowledge of reliable fracture toughness parameters characterising the initiation of the failure process in the whole relevant temperature range. From a large number of fracture mechanics tests a statistically based procedure was derived allowing to quantify the initiation of fracture toughness as a function of temperature as a closed function as well as the temperature dependence of the cleavage instability parameters. Alternatively to the direct experimental determination one also can use a correlation between fracture toughness and notch impact energy. (orig.)

  20. Scaphoid fractures in children

    Directory of Open Access Journals (Sweden)

    Gajdobranski Đorđe

    2014-01-01

    Full Text Available Introduction. Scaphoid fractures are rare in childhood. Diagnosis is very difficult to establish because carpal bones are not fully ossified. In suspected cases comparative or delayed radiography is used, as well as computerized tomography, magnetic resonance imaging, ultrasound and bone scintigraphy. Majority of scaphoid fractures are treated conservatively with good results. In case of delayed fracture healing various types of treatment are available. Objective. To determine the mechanism of injury, clinical healing process, types and outcome of treatment of scaphoid fractures in children. Methods. We retrospectively analyzed patients with traumatic closed fracture of the scaphoid bone over a ten-year period (2002-2011. The outcome of the treatment of “acute” scaphoid fracture was evaluated using the Mayo Wrist Score. Results. There were in total 34 patients, of mean age 13.8 years, with traumatic closed fracture of the scaphoid bone, whose bone growth was not finished yet. Most common injury mechanism was fall on outstretched arm - 76% of patients. During the examined period 31 children with “acute” fracture underwent conservative treatment, with average immobilization period of 51 days. Six patients were lost to follow-up. In the remaining 25 patients, after completed rehabilitation, functional results determined by the Mayo Wrist Score were excellent. Conclusion. Conservative therapy of “acute” scaphoid fractures is an acceptable treatment option for pediatric patients with excellent functional results.

  1. Fracture of the styloid process associated with the mandible fracture

    Directory of Open Access Journals (Sweden)

    K N Dubey

    2013-01-01

    Full Text Available Fracture of the styloid process (SP of temporal bone is an uncommon injuries. Fracture of the SP can be associated with the facial injuries including mandible fracture. However, injury to the SP may be concealed and missed diagnosis may lead to the improper or various unnecessary treatments. A rare case of SP fracture associated with the ipsilateral mandibular fracture and also the diagnostic and management considerations of the SP fracture are discussed.

  2. The Process of Hydraulic Fracturing

    Science.gov (United States)

    Hydraulic fracturing, know as fracking or hydrofracking, produces fractures in a rock formation by pumping fluids (water, proppant, and chemical additives) at high pressure down a wellbore. These fractures stimulate the flow of natural gas or oil.

  3. Pre-operative haematological investigations in paediatric orofacial ...

    African Journals Online (AJOL)

    Pre-operative haematological investigations in paediatric orofacial cleft repair: Any relevance to management outcome? ... Aim and Objectives: To determine the value of routine pre-operative haematologic investigations in children undergoing orofacial cleft repair. Background: Although routine pre-operative laboratory ...

  4. admission patterns and outcomes of paediatric patients admitted at ...

    African Journals Online (AJOL)

    OBJECTIVE To determine patterns of admissions due to diarrhea and their outcomes of paediatric patients at Muhimbili National Hospital (MNH). METHODOLOGY A hospital-based prospective study including all children admitted to the Diarrhea Unit during the study period. Data was collected using content analysis ...

  5. Paediatric chronic kidney disease | van Biljon | South African ...

    African Journals Online (AJOL)

    Doctors use various guidelines on paediatric chronic kidney disease (CKD) for managing their patients according to the availability of resources. As with adolescent and adult patients, CKD in children can also progress to end-stage renal failure – the time course being influenced by several modifiable factors. Decline in ...

  6. Variation in radiographic protocols in paediatric interventional cardiology

    International Nuclear Information System (INIS)

    McFadden, S L; Hughes, C M; Winder, R J

    2013-01-01

    The aim of this work is to determine current radiographic protocols in paediatric interventional cardiology (IC) in the UK and Ireland. To do this we investigated which imaging parameters/protocols are commonly used in IC in different hospitals, to identify if a standard technique is used and illustrate any variation in practice. A questionnaire was sent to all hospitals in the UK and Ireland which perform paediatric IC to obtain information on techniques used in each clinical department and on the range of clinical examinations performed. Ethical and research governance approval was sought from the Office for Research Ethics Committees Northern Ireland and the individual trusts. A response rate of 79% was achieved, and a wide variation in technique was found between hospitals. The main differences in technique involved variations in the use of an anti-scatter grid and the use of additional filtration to the radiation beam, frame rates for digital acquisition and pre-programmed projections/paediatric specific programming in the equipment. We conclude that there is no standard protocol for carrying out paediatric IC in the UK or Ireland. Each hospital carries out the IC procedure according to its own local protocols resulting in a wide variation in radiation dose. (paper)

  7. The six-minute walk test in paediatric populations

    NARCIS (Netherlands)

    Janke de Groot

    2011-01-01

    The six-minute walk test (6MWT) is a self-paced, submaximal exercise test used to assess functional exercise capacity in patients with chronic diseases (Chang 2006, Solway et al 2001). It has been used widely in adults, and is being utilised increasingly in paediatric populations; it has been used

  8. Paediatric surgical abdominal emergencies in a north central ...

    African Journals Online (AJOL)

    Paediatric surgical abdominal emergencies in a north central Nigerian centre. ... The causes of PSAEs vary worldwide, and the management is challenging, often with unimaginably poor outcome if not carefully handled. The aim of this ... Keywords: abdominal emergencies, acute abdomen, children, morbidity, mortality ...

  9. Paediatric Palliative Care and Intellectual Disability--A Unique Context

    Science.gov (United States)

    Duc, Jacqueline K.; Herbert, Anthony Robert; Heussler, Helen S.

    2017-01-01

    Background: Paediatric palliative care is a nuanced area of practice with additional complexities in the context of intellectual disability. There is currently minimal research to guide clinicians working in this challenging area of care. Method: This study describes the complex care of children with life-limiting conditions and intellectual…

  10. Unmet needs in paediatric psychopharmacology : Present scenario and future perspectives

    NARCIS (Netherlands)

    Persico, Antonio M.; Arango, Celso; Buitelaar, Jan K.; Correll, Christoph U.; Glennon, Jeffrey C.; Hoekstra, Pieter J.; Moreno, Carmen; Vitiello, Benedetto; Vorstman, Jacob; Zuddas, Alessandro

    2015-01-01

    Paediatric psychopharmacology holds great promise in two equally important areas of enormous biomedical and social impact, namely the treatment of behavioural abnormalities in children and adolescents, and the prevention of psychiatric disorders with adolescent- or adult-onset. Yet, in striking

  11. The role of computed tomography in modern paediatric uroradiology

    International Nuclear Information System (INIS)

    Maudgil, D.D.; McHugh, K.

    2002-01-01

    Computed tomography (CT) has developed a well-recognised role within paediatric uroradiology, especially in imaging of trauma, malignancy (in particular Wilms' tumour), atypical infection, and congenital urogenital abnormalities. CT can also be used for problem solving in nephrolithiasis and renal transplant assessment. These applications are illustrated and discussed, with an emphasis on particular information that can be gained from the CT study

  12. A practical approach to anaesthesia for paediatric liver transplantation

    African Journals Online (AJOL)

    Adele

    REVIEW. Introduction. The first liver transplant in children was performed by Starzl in ... program has performed 79 transplants in 76 patients with ... Paediatric liver transplantation in South Africa, up until the present time, has been centered at the Red Cross Children's Hospital ..... infrahepatic connections (i.e. steps 1 and 2).

  13. Congenital anomalies in paediatric surgery in North India | Jangra ...

    African Journals Online (AJOL)

    All the data were entered in the excel spread sheet and analysed in SPSS version 17. (Statistical Package for the Social Sciences, a software package used for statistical analysis, officially named “IBM SPSS Statistics”). Results:Over the decade, a total of 14264 children were admitted in the paediatric surgery department ...

  14. Adalimumab for the treatment of refractory noninfectious paediatric uveitis.

    Science.gov (United States)

    Muñoz-Gallego, Alicia; Barral, Estefanía; Enríquez, Eugenia; Tejada, Pilar; Barceló, Ana; de Inocencio, Jaime

    2017-06-01

    To report the experience of our center with the use of adalimumab (ADA) for the treatment of severe refractory noninfectious paediatric uveitis. The study is a retrospective case series of all paediatric patients with refractory uveitis who were treated with ADA at the Paediatric Uveitis Unit of our center from 2008 to 2015. We present 12 patients (6 Juvenile idiopathic arthritis-associated uveitis, 4 idiopathic panuveitis, 1 early-onset sarcoidosis-associated panuveitis, and 1 intermediate uveitis), with uveitis in 19/24 eyes. Once ADA therapy was started, all the patients presented improved activity according to Standardization of Uveitis Nomenclature (SUN) criteria. Nine out of the 12 patients had structural damage before ADA could be started: cataract (n = 4), glaucoma (n = 2), cystic macular edema (n = 1), exudative retinal detachment (n = 1), and optic disk edema (n = 5). Visual acuity improved or maintained stable in 17/19 affected eyes, and only 2 eyes decreased its visual acuity because of structural damage, which was already present before ADA therapy. In our experience, ADA presents a good safety profile and is efficacious in the treatment of paediatric patients with different forms of refractory noninfectious uveitis.

  15. changing therapy changing antiretroviral therapy in paediatric patients

    African Journals Online (AJOL)

    2005-11-01

    Nov 1, 2005 ... Readers are referred to the SA HIV Clinicians Guidelines for. Paediatric ART (p. 18, this issue). When a patient exhibits intolerance to or toxicity from a single drug it may be .... malabsorptive states may not be absorbing their ARV ... someone highly experienced in the field who also has all the details of the ...

  16. The role of anaesthetists in paediatric intensive care units

    African Journals Online (AJOL)

    Adele

    to various surgical and critical care disciplines, the usefulness of a paediatric intensive care unit (PICU) rotation was investigated. A brief overview of the experiences of anaesthetic registrars at a. South African teaching hospital rotating through a PICU is pre- sented, as well as the potential advantages for both trainees and.

  17. Gonad shielding in paediatric pelvic radiography : Disadvantages prevail over benefit

    NARCIS (Netherlands)

    Frantzen, M.J.; Robben, S.; Postma, A.A.; Zoetelief, J.; Wildberger, J.E.; Kemerink, G.J.

    2012-01-01

    Objective To re-evaluate gonad shielding in paediatric pelvic radiography in terms of attainable radiation risk reduction and associated loss of diagnostic information. Methods A study on patient dose and the quality of gonad shielding was performed retrospectively using 500 pelvic radiographs of

  18. Medication Administration Errors Involving Paediatric In-Patients in a ...

    African Journals Online (AJOL)

    Erah

    In-Patients in a Hospital in Ethiopia. Yemisirach Feleke ... Purpose: To assess the type and frequency of medication administration errors (MAEs) in the paediatric ward of .... prescribers, does not go beyond obeying ... specialists, 43 general practitioners, 2 health officers ..... Medication Errors, International Council of Nurses.

  19. The use of alternative lipid emulsions in paediatric and neonatal ...

    African Journals Online (AJOL)

    The newer lipid emulsion containing fish oil has been shown to reduce the risk ... Prolonged parenteral nutrition (PPN) is essential in those paediatric patients who are ... stress, prolonged inflammation and the role of phytosterols.7,8. Oxidative .... risk of hypertrygliceridaemia due to their limited muscle and fat mass and ...

  20. Computational hybrid anthropometric paediatric phantom library for internal radiation dosimetry

    DEFF Research Database (Denmark)

    Xie, Tianwu; Kuster, Niels; Zaidi, Habib

    2017-01-01

    for children demonstrated that they follow the same trend when correlated with age. The constructed hybrid computational phantom library opens up the prospect of comprehensive radiation dosimetry calculations and risk assessment for the paediatric population of different age groups and diverse anthropometric...

  1. [The prevention of pressure sores in paediatric intensive care].

    Science.gov (United States)

    Thueux, Emilie

    2014-01-01

    In paediatric intensive care, children develop pressure sores as a result of various mechanical and clinical factors. The prevention and assessment of the risk of pressure sores constitute a key concern for the nursing teams which establish prevention strategies adapted to the young patients.

  2. Morbidity and mortality of neonates admitted in general paediatric ...

    African Journals Online (AJOL)

    There were only six admissions to the general purpose intensive care unit referred from the wards. The independent predictors of mortality were low birth weight, apnoec attacks, hypothermia and dehydration(p<0.05). Conclusion: The mortality rate for neonates admitted to the general paediatric wards is high with almost ...

  3. African Journal of Paediatric Surgery - Vol 11, No 2 (2014)

    African Journals Online (AJOL)

    African Journal of Paediatric Surgery. ... High drain amylase and lipase values predict post-operative pancreatitis for ... Intractable chronic constipation in children: Outcome after anorectal myectomy · EMAIL FULL TEXT EMAIL FULL TEXT ... Outcomes of conservative treatment of giant omphaloceles with dissodic 2% ...

  4. Bacteria isolated from the airways of paediatric patients with ...

    African Journals Online (AJOL)

    Knowledge of which bacteria are found in the airways of paediatric patients with bronchiectasis unrelated to cystic fibrosis. (CF) is important in defining empirical antibiotic guidelines for the treatment of acute infective exacerbations. Objective. To describe the bacteria isolated from the airways of children with non-CF ...

  5. Variation in radiographic protocols in paediatric interventional cardiology.

    Science.gov (United States)

    McFadden, S L; Hughes, C M; Winder, R J

    2013-06-01

    The aim of this work is to determine current radiographic protocols in paediatric interventional cardiology (IC) in the UK and Ireland. To do this we investigated which imaging parameters/protocols are commonly used in IC in different hospitals, to identify if a standard technique is used and illustrate any variation in practice. A questionnaire was sent to all hospitals in the UK and Ireland which perform paediatric IC to obtain information on techniques used in each clinical department and on the range of clinical examinations performed. Ethical and research governance approval was sought from the Office for Research Ethics Committees Northern Ireland and the individual trusts. A response rate of 79% was achieved, and a wide variation in technique was found between hospitals. The main differences in technique involved variations in the use of an anti-scatter grid and the use of additional filtration to the radiation beam, frame rates for digital acquisition and pre-programmed projections/paediatric specific programming in the equipment. We conclude that there is no standard protocol for carrying out paediatric IC in the UK or Ireland. Each hospital carries out the IC procedure according to its own local protocols resulting in a wide variation in radiation dose.

  6. Paediatric palliative care providers' experiences in rural KwaZulu ...

    African Journals Online (AJOL)

    based palliative care (including paediatric palliative care) is available to patients in rural ... reported that one of the most distressing tasks a nurse has to carry out is telling any .... die, as a miracle (such as a cure) is presented as a possibility.

  7. The value of case management in paediatric palliative care

    NARCIS (Netherlands)

    Verberne, L.M.

    2017-01-01

    In the Netherlands around 4000 – 6700 children with life-limiting diseases could benefit from paediatric palliative care (PPC). However, adequate PPC is often absent due to the lack of continuity and coordination of care and limited expertise among healthcare professionals (HCP). Consequently, many

  8. An Analysis of Disorders seen at the Paediatric Neurology Clinic ...

    African Journals Online (AJOL)

    BACKGROUND: Paediatric neurological disorders constitute a major cause of disability in childhood. Children in the developing countries are disproportionately affected and in addition face the added burden of poverty, inadequate health facilities, stigmatisation and lack of facilities for rehabilitative care. OBJECTIVE: To ...

  9. Glomerular filtration rate profiles in paediatric patients on cancer ...

    African Journals Online (AJOL)

    Subjects: Paediatric patients who had an established diagnosis of cancer and had been on chemotherapy for at least six months. Results: Out of the 115 children enrolled in the study 43 had abnormal kidney function. This gave a prevalence of 37% (95%CI 28-46).The other 72 children had normal kidney function. Patients ...

  10. The paediatric acute scrotum: are we still managing correctly ...

    African Journals Online (AJOL)

    Summary background Diagnosis and management of the paediatric acute scrotum remains an elusive and often challenging area of urology. In response to this, the urology team developed local guidelines to aid the management and treatment of this potentially life-changing condition. Patients and methods We reviewed ...

  11. Paediatric thoracoscopy: State of the art | Van Niekerk | South ...

    African Journals Online (AJOL)

    Many advanced procedures, including lobectomy, repair of tracheo-oesophageal fistula, excision of mediastinal tumours and diaphragmatic hernia repairs, are being done routinely in paediatric surgery centres around the world. This article reviews the state of the art of thoracoscopic surgery in children. The author selected ...

  12. Mortality Pattern within Twenty-Four Hours of Emergency Paediatric ...

    African Journals Online (AJOL)

    The highest mortality within the first 24 hours of admission was recorded among patients with malaria (89.0%) followed by protein energy malnutrition. CONCLUSION: Majority of deaths among emergency paediatric admission occur within the first 24 hours of admission and are associated with clinical conditions such as ...

  13. Institutional review boards' attitudes towards remuneration in paediatric research

    DEFF Research Database (Denmark)

    Flege, Marius M; Thomsen, Simon F

    2017-01-01

    Remuneration in paediatric research poses an ethical dilemma. Too large a sum might cause parents to enrol their children in research projects with no benefit for the child, whereas too modest a sum might hamper recruitment. The institutional review boards have the responsibility to only approve ...

  14. Paediatric Drug Development and Formulation Design-a European Perspective

    NARCIS (Netherlands)

    Nales, D.A.; Kozarewicz, Piotr; Aylward, Brian; de Vries, Rutger; Egberts, Toine C G; Rademaker, Carin M A; Schobben, Alfred F A M

    The availability of licensed paediatric drugs is lagging behind those for adults, and there is a lack of safe formulations in suitable doses that children are able and willing to take. As a consequence, children are commonly treated with off-label or unlicensed drugs. As off-label and unlicensed

  15. Paediatric Drug Development and Formulation Design—a European Perspective

    NARCIS (Netherlands)

    van Riet-Nales, Diana A.; Kozarewicz, Piotr; Aylward, Brian; de Vries, Rutger; Egberts, Toine C G; Rademaker, Carin M A; Schobben, Alfred F A M

    The availability of licensed paediatric drugs is lagging behind those for adults, and there is a lack of safe formulations in suitable doses that children are able and willing to take. As a consequence, children are commonly treated with off-label or unlicensed drugs. As off-label and unlicensed

  16. Ventriculostomy infections at the paediatric neurosurgical unit at Dr ...

    African Journals Online (AJOL)

    of patients admitted to the paediatric neurosurgical unit at the hospital between January 2010 and December 2013, who had had an EVD inserted as part of their treatment, and if all records were accurate, legible and complete. Patients were excluded from the study if they were older than 12 years. Information was sourced ...

  17. African Journal of Paediatric Surgery - Vol 10, No 3 (2013)

    African Journals Online (AJOL)

    The management of dog bite injuries of genitalia in paediatric age · EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT ... The use of Proceed mesh in ventral hernias: A pilot study on 22 cases · EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL ...

  18. Paediatric cardiac anaesthesia in sickle cell disease: a case series

    African Journals Online (AJOL)

    Paediatric patients with SCD and congenital heart defects may require ... Patients with sickle cell disease (SCD) presenting for cardiac ... fluid, calculated according to body weight, was initiated. ... oxygen mixture and intravenous fentanyl (5–10 mcg/kg) and .... erythropoiesis, and in this way reduces HbS production.

  19. The ESSKA paediatric anterior cruciate ligament monitoring initiative.

    Science.gov (United States)

    Moksnes, Håvard; Engebretsen, Lars; Seil, Romain

    2016-03-01

    To survey and describe the treatment of paediatric anterior cruciate ligament (ACL) injuries performed by orthopaedic surgeons affiliated with the European Society for Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA). A closed e-survey was submitted to all registered members and affiliates of ESSKA in July 2013. All recipients were invited to participate in the survey by answering 34 questions online. The list of potential respondents was extracted from the ESSKA office database. Invitation was sent to 2236 ESSKA members and affiliates, and received 491 (22%) unique responses. Among the respondents, 445 (91%) were orthopaedic surgeons, with 354 (72%) stating that they were involved in treatment of paediatric ACL injuries. The main findings were that there are substantial differences with regard to preferred treatment algorithms, surgical techniques and long-term follow-up procedures. The summed estimate of skeletally immature children with ACL injury seen by the responders in 2012 was minimum 1923 individuals, and a minimum of 102 clinically relevant post-operative growth disturbances were registered. The present survey documents that the incidences of paediatric ACL injuries and idiopathic growth disturbances may be higher than previously estimated. Treatment algorithms and surgical techniques are highly diverse, and consensus could not be identified. It is worrying that only half the surgeons reported to follow-up children until skeletal maturity after surgical treatment. The results of this survey highlight the importance of international multicentre studies on paediatric ACL treatment and the development of an outcome registry to enable prospective data collections. IV.

  20. 6. Radiation Recall; A Paediatric Case Report From University ...

    African Journals Online (AJOL)

    Esem

    Given that radiotherapy and chemotherapy have such a close relationship in a multitude of cancers we feel it increasingly important to further understand this phenomenon and specifically its associations with certain drugs and susceptible individuals. To the best of our knowledge this is the first documented paediatric case ...

  1. paediatric ureteric calculi: in-situ extracorporeal shock wave lithotripsy

    African Journals Online (AJOL)

    Objective To evaluate prospectively the efficacy of in-situ extracorporeal shock wave lithotripsy (ESWL) in the treatment of ureteric calculi in the paediatric age group. Patients and Methods Twenty children (aged 2.2 16 years) with 22 ureteric stones were evaluated and treated with in-situ ESWL using the Dornier S lithotripter ...

  2. Unmet needs in paediatric psychopharmacology: Present scenario and future perspectives

    NARCIS (Netherlands)

    Persico, A.M.; Arango, C.; Buitelaar, J.K.; Correll, C.U.; Glennon, J.C.; Hoekstra, P.J.; Moreno, C.; Vitiello, B.; Vorstman, J.; Zuddas, A.

    2015-01-01

    Paediatric psychopharmacology holds great promise in two equally important areas of enormous biomedical and social impact, namely the treatment of behavioural abnormalities in children and adolescents, and the prevention of psychiatric disorders with adolescent- or adult-onset. Yet, in striking

  3. Accuracy of radiographer reporting of paediatric brain CT

    International Nuclear Information System (INIS)

    Brandt, Andrew; Louw, Brand; Dekker, Gerrit; Andronikou, Savvas; Wieselthaler, Nicki; Kilborn, Tracy; Bertelsman, Jessica; Dreyer, Catherine

    2007-01-01

    Radiographer reporting has been studied for plain films and for ultrasonography, but not in paediatric brain CT in the emergency setting. To study the accuracy of radiographer reporting in paediatric brain CT. We prospectively collected 100 paediatric brain CT examinations. Films were read from hard copies using a prescribed tick sheet. Radiographers with 12 years' and 3 years' experience, respectively, were blinded to the history and were not trained in diagnostic film interpretation. The radiographers' results were compared with those of a consultant radiologist. Three categories were defined: abnormal scans, significant abnormalities and insignificant abnormalities. Both radiographers had an accuracy of 89.5% in reading a scan correctly as abnormal, and radiographer 1 had a sensitivity of 87.8% and radiographer 2 a sensitivity of 96%. Radiographer 1 had an accuracy in detecting a significant abnormality of 75% and radiographer 2 an accuracy of 48.6%, and the sensitivities for this category were 61.6% and 52.9%, respectively. Results for detecting the insignificant abnormalities were poorer. Selected radiographers could play an effective screening role, but lacking the sensitivity required for detecting significant abnormality, they could not be the final diagnostician. We recommend that the study be repeated after both radiographers have received formal training in interpretation of paediatric brain CT. (orig.)

  4. Paediatric HIV/AIDS in Abakaliki | Ojukwu | Nigerian Journal of ...

    African Journals Online (AJOL)

    Objectives: The study was aimed at determining the mode of transmission, clinical presentation, and outcome of HIV infection in children admitted with clinical manifestations suspicious of HIV infection. It was also to examine whether the WHO clinical case definition for paediatric AIDS in Africa could help predict the infection ...

  5. Factors influencing choice of paediatrics as a career among medical ...

    African Journals Online (AJOL)

    None of the male students but 12 of the female students (30%) considered gender distribution to be a factor influencing their career choice (p=0.046). Conclusion. This study indicates that paediatrics is popular among female students and that several factors influence choice of this specialty. Understanding these factors may ...

  6. Post-operative pain management in paediatric surgery at Sylvanus ...

    African Journals Online (AJOL)

    Background: The aim of this study was to evaluate pain management in paediatric surgery at Sylvanus Olympio University Teaching Hospital, Lome. Patients and Methods: A prospective descriptive study was conducted in the Department of Anaesthesiology and Intensive Care at Sylvanus Olympio teaching hospital from 1 ...

  7. Assessment of Parents' Satisfaction with Paediatric Surgery Services ...

    African Journals Online (AJOL)

    Ademuyıwa O Adesoji

    Items 1 - 14 ... Services at a Tertiary Hospital in South West Nigeria: A Quality Control ... literate parents of paediatric post-op patients were serially recruited from the pediatric .... such as poor electricity and water supply in a survey of dental.

  8. Epidemiology of paediatric poisoning reporting to a tertiary hospital ...

    African Journals Online (AJOL)

    The median age of the children was 24 months (interquartile range 24 - 48 months). Kerosene was the leading cause of poisoning (39.5%). Conclusion. Paediatric poisoning is a major health hazard in children living in Kumasi and its environs. This can possibly be attributed to a lack of adequate supervision of children and ...

  9. Radiopharmaceutical activities administered for paediatric nuclear medicine procedures in Australia

    International Nuclear Information System (INIS)

    Towson, J.E.; Smart, R.C.; Rossleigh, M.A.

    2001-01-01

    A survey of radiopharmaceutical activities used at the eight hospital centres specialising in paediatric nuclear medicine in Australia was conducted in 1999-2000 by the Australian and New Zealand Society of Nuclear Medicine and the Australasian Radiation Protection Society. Data on the maximum and minimum administered activities (A max and A min ) as obtained for 43 paediatric imaging procedures are presented. The results are also available on the ANZSNM and ARPS websites at: http://www.anzsnm.org.au and http://www.arps.org.au. The A max values were significantly less than the corresponding Reference Activities for adults determined in a previous study. Activities for individual patients are calculated using surface area scaling at five centres and body weight scaling at three centres. The median values of A max and A min are recommended as Paediatric Reference Activities. The effective dose to patients of various sizes for the Paediatric Reference Activities and both methods of scaling was calculated for each procedure. Copyright (2000) The Australian and New Zealand Society of Nuclear Medicine Inc

  10. Cardiac Arrest after Local Anaesthetic Toxicity in a Paediatric Patient

    Directory of Open Access Journals (Sweden)

    Liana Maria Torres de Araújo Azi

    2016-01-01

    Full Text Available We report a case of a paediatric patient undergoing urological procedure in which a possible inadvertent intravascular or intraosseous injection of bupivacaine with adrenaline in usual doses caused subsequent cardiac arrest, completely reversed after administration of 20% intravenous lipid emulsion. Early diagnosis of local anaesthetics toxicity and adequate cardiovascular resuscitation manoeuvres contribute to the favourable outcome.

  11. African Journal of Paediatric Surgery - Vol 8, No 3 (2011)

    African Journals Online (AJOL)

    Preemptive analgesia in paediatric surgery · EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT ... Comparison between late-presenting and isolated neonatal congenital diaphragmatic hernias · EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL ...

  12. African Journal of Paediatric Surgery - Vol 11, No 3 (2014)

    African Journals Online (AJOL)

    Oesophageal foreign body in children: 15 years experience in a tertiary care paediatric centre · EMAIL FULL TEXT EMAIL FULL TEXT DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. A Singh, M Bajpai, SS Panda, K Chand, M Jana, A Ali, 238-241 ...

  13. [Trochanteric femoral fractures].

    Science.gov (United States)

    Douša, P; Čech, O; Weissinger, M; Džupa, V

    2013-01-01

    At the present time proximal femoral fractures account for 30% of all fractures referred to hospitals for treatment. Our population is ageing, the proportion of patients with post-menopausal or senile osteoporosis is increasing and therefore the number of proximal femoral fractures requiring urgent treatment is growing too. In the age category of 50 years and older, the incidence of these fractures has increased exponentially. Our department serves as a trauma centre for half of Prague and part of the Central Bohemia Region with a population of 1 150 000. Prague in particular has a high number of elderly citizens. Our experience is based on extensive clinical data obtained from the Register of Proximal Femoral Fractures established in 1997. During 14 years, 4280 patients, 3112 women and 1168 men, were admitted to our department for treatment of proximal femoral fractures. All patients were followed up until healing or development of complications. In the group under study, 82% were patients older than 70 years; 72% of those requiring surgery were in their seventies and eighties. Men were significantly younger than women (pfractures were 2.3-times more frequent in women than in men. In the category under 60 years, men significantly outnumbered women (pfractures were, on the average, eight years older than the patients with intertrochanteric fractures, which is a significant difference (pTrochanteric fractures accounted for 54.7% and femoral neck fractures for 45.3% of all fractures. The inter-annual increase was 5.9%, with more trochanteric than femoral neck fractures. There was a non-significant decrease in intertrochanteric (AO 31-A3) fractures. On the other hand, the number of pertrochanteric (AO 31-A1+2) fractures increased significantly (pfractures were treated with a proximal femoral nail; a short nail was used in 1260 and a long nail in 134 of them. A dynamic hip screw (DHS) was employed to treat 947 fractures. Distinguishing between pertrochanteric (21-A1

  14. A review of epidemiology of paediatric elbow injuries in sports.

    Science.gov (United States)

    Magra, Merzesh; Caine, Dennis; Maffulli, Nicola

    2007-01-01

    The elbow is a common site of orthopaedic injury in the paediatric population. The number of these injuries continues to rise following increased levels of participation in paediatric recreational and competitive sport. Injuries to the paediatric elbow can be classified as either overuse or acute. Delineating injury patterns to the elbow in children can be challenging, given the cartilaginous composition of the distal humerus and the multiple secondary ossification centres that appear and unite with the epiphysis at defined ages. Pitching in baseball, serving in tennis, spiking in volleyball, passing in American football and launching in javelin-throwing can all produce elbow pathology by forceful valgus stress, with medial stretching, lateral compression and posterior impingement. In children and adolescents, the epiphyseal plate is weaker than the surrounding ligaments, predisposing them to epiphyseal plate injuries. On the other hand, post-pubescent or skeletally mature athletes are more prone to tendinous or ligamentous injury. Injuries may cause significant impact on the athlete, parents and healthcare system. With the exception of baseball, there are few prospective cohort studies on the epidemiological trends of childhood elbow injuries in other sports. This paper aims to describe the epidemiological trends in paediatric elbow injuries related to sports, suggests prevention strategies and discusses the scope for further research. A web-based search of existing articles pertaining to paediatric elbow injuries in sports was performed. The implications of acute and overuse injuries and the possibility of permanent damage should be understood by parents, coaches and the athletes. Proper understanding of the intrinsic and extrinsic risk factors that could lead to elbow injuries is thus required. Measures to prevent elbow injuries should include proper coaching, warm-up, officiation, legislation, medical expertise and protective gear. There are still many

  15. The prevalence of pressure ulcers in the paediatric population.

    Science.gov (United States)

    Habiballah, Laila; Tubaishat, Ahmad

    2016-05-01

    A paucity of research related to the problem of pressure ulcers in paediatrics is found, with a variety of reported prevalence rates. To record the prevalence, location and categories of PU in the inpatient paediatric wards, and to identify the characteristics of pressure ulcer patients. A descriptive point prevalence study. All paediatric inpatient wards in two hospitals in Jordan. One of which is a university-affiliated hospital and the other a paediatric public hospital. Isolation, burn and emergency units, outpatients' clinics and psychiatric wards were excluded. One sixty six paediatric patients aged from one day up to 18 years from both hospitals. Patients who met the inclusion criteria were included and examined for the existence of pressure ulcers on one day in each hospital by the primary investigator. The European Pressure Ulcer Advisory Panel classification system was used to categorise each identified ulcer. The characteristics of ulcers were collected as well. Sixteen ulcers were identified in 11 patients, giving a prevalence rate of 6.6%.When Category I ulcers were excluded, the prevalence rate dropped to 2.4%. All except one of the PU patients were being treated in critical care units (n = 10, 90.9%), and most of the ulcers were category one (n = 7, 63.6%) and caused by devices (n = 7, 63.6). The face was the most frequently reported location of PUs (n = 6, 54.5%), followed by the occiput (n = 2, 18.2%). Most PU patients were male (n = 6, 54.5%), and less than 12 months old (n = 8, 72.7%). PU patients had experienced longer hospital stays than patients free from PU (U = 499.0, p = 0.02). Jordanian paediatric patients do have pressure ulcers, with a prevalence rate congruent with previously reported international rates. Most of the ulcers found were caused by devices used in critical care units. This should encourage nurses to pay extra attention to their paediatric patients when they are connected to medical devices. Copyright

  16. Family functioning in paediatric obsessive compulsive and related disorders.

    Science.gov (United States)

    Murphy, Yolanda E; Flessner, Christopher A

    2015-11-01

    Research among youths with obsessive compulsive disorder (OCD) has shown a significant relationship between illness severity, treatment outcome, and the family environment yet little work has been undertaken among the broader class of obsessive compulsive and related disorders (OCRDs) - Trichotillomania, body dysmorphic disorder (BDD), skin picking disorder (SPD), and hoarding. The aim of this study was to (1) review the family functioning literature among paediatric OCRDs, (2) address limitations to previous studies, and (3) highlight areas in need of further research. A review of the literature was conducted using several databases (i.e., Google Scholar, PubMed, ScienceDirect) and employing key search terms (e.g., 'family functioning', 'paediatric OCD'). The resultant articles examined several domains subsumed under the broader heading of family environment including parental mental health, parenting practices, family dynamics, family involvement with symptoms, and family emotional climate. The literature reviewed demonstrated a strong relationship between paediatric OCD and adverse family functioning (e.g., parental symptoms of anxiety and depression, family accommodation, family strain and stress, parental guilt and fear) in all identified domains. While family functioning research in paediatric HPD was relatively scant, research suggested similar familial dysfunction (e.g., limited independence, low family cohesion, family violence). Collectively, only 1 article, examining BDD, assessed family functioning within other OCRDs. This review supports the need for further research in the OCRDs. Limitations to the available literature and targeted suggestions for future research are discussed. The domains of family environment in this study indicate specific family functioning deficits that may serve as aetiological and/or maintenance factors in paediatric OCRDs, possibly contributing to the understanding of these complex disorders. The recognition of family deficits

  17. Early diagnosis of thoracolumbar spine fractures in children. A prospective study.

    Science.gov (United States)

    Leroux, J; Vivier, P-H; Ould Slimane, M; Foulongne, E; Abu-Amara, S; Lechevallier, J; Griffet, J

    2013-02-01

    Early detection of spine fractures in children is difficult because the clinical examination does not always raise worrisome symptoms and the vertebrae are still cartilaginous, and consequently incompletely visualized on routine X-rays. Therefore, diagnosis is often delayed or missed. The search for a "breath arrest" sensation at the moment of the trauma improves early detection of thoracolumbar spine fractures in children. This was a prospective monocentric study including all children consulting at the paediatric emergency unit of a single university hospital with a thoracolumbar spine trauma between January 2008 and March 2009. All children had the same care. Pain was quantified when they arrived using the visual analog scale. Clinical examination searched for a "breath arrest" sensation at the moment of the trauma and noted the circumstances of the accident. X-rays and MRI were done in all cases. Fifty children were included with a mean age of 11.4 years. Trauma occurred during games or sports in 94% of the cases. They fell on the back in 72% cases. Twenty-three children (46%) had fractures on the MRI, with a mean number of four fractured vertebrae (range, 1-10). Twenty-one of them (91%) had a "breath arrest" sensation. Fractures were not visualized on X-rays in five cases (22%). Twenty-seven children had no fracture; 19 of them (70%) did not feel a "breath arrest". Fractures were suspected on X-rays in 15 cases (56%). The search for a "breath arrest" sensation at the moment of injury improves early detection of thoracolumbar spine fractures in children (Se=87%, Sp=67%, PPV=69%, NPV=86%). When no fracture is apparent on X-rays and no "breath arrest" sensation is expressed by the child, the clinician can be sure there is no fracture (Se=26%, Sp=100%, PPV=100%, NPV=53%). Level III. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  18. Hand fracture - aftercare

    Science.gov (United States)

    ... an orthopedic surgeon if: Your metacarpal bones are broken and shifted out of place Your fingers do not line up correctly Your fracture nearly went through the skin Your fracture went through the skin Your pain is severe or becoming worse Self-care at Home You may have pain and swelling for 1 ...

  19. TIBIAL SHAFT FRACTURES.

    Science.gov (United States)

    Kojima, Kodi Edson; Ferreira, Ramon Venzon

    2011-01-01

    The long-bone fractures occur most frequently in the tibial shaft. Adequate treatment of such fractures avoids consolidation failure, skewed consolidation and reoperation. To classify these fractures, the AO/OTA classification method is still used, but it is worthwhile getting to know the Ellis classification method, which also includes assessment of soft-tissue injuries. There is often an association with compartmental syndrome, and early diagnosis can be achieved through evaluating clinical parameters and constant clinical monitoring. Once the diagnosis has been made, fasciotomy should be performed. It is always difficult to assess consolidation, but the RUST method may help in this. Radiography is assessed in two projections, and points are scored for the presence of the fracture line and a visible bone callus. Today, the dogma of six hours for cleaning the exposed fracture is under discussion. It is considered that an early start to intravenous antibiotic therapy and the lesion severity are very important. The question of early or late closure of the lesion in an exposed fracture has gone through several phases: sometimes early closure has been indicated and sometimes late closure. Currently, whenever possible, early closure of the lesion is recommended, since this diminishes the risk of infection. Milling of the canal when the intramedullary nail is introduced is still a controversial subject. Despite strong personal positions in favor of milling, studies have shown that there may be some advantage in relation to closed fractures, but not in exposed fractures.

  20. Physeal Fractures in Foals.

    Science.gov (United States)

    Levine, David G; Aitken, Maia R

    2017-08-01

    Physeal fractures are common musculoskeletal injuries in foals and should be included as a differential diagnosis for the lame or nonweightbearing foal. Careful evaluation of the patient, including precise radiographic assessment, is paramount in determining the options for treatment. Prognosis mostly depends on the patient's age, weight, and fracture location and configuration. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. A CLINICAL STUDY AND MANAGEMENT OF PAEDIATRIC CATARACT, OUR EXPERIENCE

    Directory of Open Access Journals (Sweden)

    Satish D. Shet

    2017-09-01

    Full Text Available BACKGROUND Control of childhood blindness is one of the priorities identified for achieving the goals of Vision-2020 by WHO. This is considered a priority because blind-years (number of years that a blind person lives after going blind due to childhood blindness are second only to cataract and half of childhood blindness is avoidable (treatable/preventable. Paediatric cataract accounts for 12% of the 1.4 million blind children globally. The prevalence of childhood cataract has been reported as 1 to 15 cases in 10,000 children in developing countries. Compared to industrialised countries, this figure is 10 times higher. Early detection and timely treatment of various childhood disorders such as congenital cataract are the most crucial factors for successful outcome. A suitable measure to address amblyopia and posterior capsule opacification post operatively is imperative for successful visual rehabilitation of such children. The objectives of this study were- 1 To study the clinical profile of paediatric cataract. 2 To evaluate the visual outcome after cataract surgery in these patients. 3 To evaluate different causes of visual impairment following management. MATERIALS AND METHODS A prospective study conducted at Karnataka institute of medical sciences department of ophthalmology from October 2015 to September 2016. All children below 14 years of age presenting with cataract will undergo thorough ophthalmologic examination and cataract surgery. RESULTS The results of the present study with 25 paediatric patients (36 eyes indicates that excellent vision can be expected after cataract surgery and posterior chamber IOL implantation coupled with appropriate amblyopia therapy. CONCLUSION The paediatric cataract patients are referred from primary health centers, and district hospital from north Karnataka to KIMS Hubli. All paediatric patients are from lower socio economic status. Early detection of cataracts and referrals to the ophthalmologist can

  2. Global shortage of neonatal and paediatric antibiotic trials: rapid review.

    Science.gov (United States)

    Thompson, Georgina; Barker, Charlotte I; Folgori, Laura; Bielicki, Julia A; Bradley, John S; Lutsar, Irja; Sharland, Mike

    2017-10-13

    There have been few clinical trials (CTs) on antibiotics that inform neonatal and paediatric drug labelling. The rate of unlicensed and off-label prescribing in paediatrics remains high. It is unclear whether the current neonatal and paediatric antibiotic research pipeline is adequate to inform optimal drug dosing. Using the ClinicalTrials.gov registry, this review aims to establish the current global status of antibiotic CTs in children up to 18 years of age. Studies were identified using key word searches of the ClinicalTrials.gov registry and were manually filtered using prespecified inclusion/exclusion criteria. 76 registered open CTs of antibiotics in children were identified globally; 23 (30%) were recruiting newborns (only 8 (11%) included preterm neonates), 52 (68%) infants and toddlers, 58 (76%) children and 54 (71%) adolescents. The majority of registered trials were late phase (10 (15%) phase 3 and 23 (35%) phase 4/pharmacovigilance). Two-thirds were sponsored by non-profit organisations, compared with pharmaceutical companies (50 (66%) vs 26 (34%), respectively). A greater proportion of non-profit funded trials were efficacy-based strategic trials (n=34, 68%), in comparison with industry-led trials, which were most often focused on safety or pharmacokinetic data (n=17, 65%). Only 2 of the 37 antibiotics listed on the May 2016 Pew Charitable Trusts antibiotic development pipeline, currently being studied in adults, appear to be currently recruiting in open paediatric CTs. This review highlights that very few paediatric antibiotic CTs are being conducted globally, especially in neonates. There is a striking disparity noted between antibiotic drug development programmes in adults and children. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  3. Case mix in paediatric rheumatology: implications for training in Australia.

    Science.gov (United States)

    Lim, Sern Chin; Allen, Roger C; Munro, Jane E; Akikusa, Jonathan D

    2012-05-01

    Despite a move towards the provision of specialist training in Australia in settings that extend beyond the public hospital system, formal comparisons of case mix between public and private specialty clinics have rarely been performed. It is therefore unclear for many specialties how well training in one setting prepares trainees for practice in the other. This study aims to compare the case mix of paediatric rheumatology patients seen in public and private settings and the referral sources of patients in each. An audit of all new patients seen in the public and private paediatric rheumatology clinics on campus at Royal Children's Hospital between June 2009 and January 2011. Data related to demographics, primary diagnosis, referral source and location seen were abstracted and compared. Eight hundred and seventy-six new patients were seen during the period of interest. Of these, 429 patients (48.9%) were seen in private clinics. The commonest diagnostic categories for both type of clinics were non-inflammatory musculoskeletal pain/orthopaedic conditions (public 39.4%, private 33.6%) followed by juvenile idiopathic arthritis (public 16.6%, %, private 18.6%), other skin/soft tissue disorders (public 8.7%, private 9.6%) and pain syndromes (public 4.9%, private 11.4%). Patients with haematological and vasculitic disorders were predominantly seen in public clinics. The commonest source of referrals to both clinics was general practitioners (public 40.6%, private 53.1%). The case mix in private paediatric rheumatology clinics closely mirrors that of public clinics at our centre. Training in either setting would provide sufficient case-mix exposure to prepare trainees for practice in the other. © 2011 The Authors. Journal of Paediatrics and Child Health © 2011 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  4. Evaluation of three paediatric weight estimation methods in Singapore.

    Science.gov (United States)

    Loo, Pei Ying; Chong, Shu-Ling; Lek, Ngee; Bautista, Dianne; Ng, Kee Chong

    2013-04-01

    Rapid paediatric weight estimation methods in the emergency setting have not been evaluated for South East Asian children. This study aims to assess the accuracy and precision of three such methods in Singapore children: Broselow-Luten (BL) tape, Advanced Paediatric Life Support (APLS) (estimated weight (kg) = 2 (age + 4)) and Luscombe (estimated weight (kg) = 3 (age) + 7) formulae. We recruited 875 patients aged 1-10 years in a Paediatric Emergency Department in Singapore over a 2-month period. For each patient, true weight and height were determined. True height was cross-referenced to the BL tape markings and used to derive estimated weight (virtual BL tape method), while patient's round-down age (in years) was used to derive estimated weights using APLS and Luscombe formulae, respectively. The percentage difference between the true and estimated weights was calculated. For each method, the bias and extent of agreement were quantified using Bland-Altman method (mean percentage difference (MPD) and 95% limits of agreement (LOA)). The proportion of weight estimates within 10% of true weight (p₁₀) was determined. The BL tape method marginally underestimated weights (MPD +0.6%; 95% LOA -26.8% to +28.1%; p₁₀ 58.9%). The APLS formula underestimated weights (MPD +7.6%; 95% LOA -26.5% to +41.7%; p₁₀ 45.7%). The Luscombe formula overestimated weights (MPD -7.4%; 95% LOA -51.0% to +36.2%; p₁₀ 37.7%). Of the three methods we evaluated, the BL tape method provided the most accurate and precise weight estimation for Singapore children. The APLS and Luscombe formulae underestimated and overestimated the children's weights, respectively, and were considerably less precise. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  5. Treatment of midfacial fractures

    International Nuclear Information System (INIS)

    Schubert, J.

    2007-01-01

    Fractures of the midface constitute half of all traumas involving facial bones. Computed tomography is very useful in primary diagnosis. Isolated fractures of the nasal bone and lateral midfacial structures may be diagnosed sufficiently by conventional X-rays. An exact description of the fracture lines along the midfacial buttresses is essential for treatment planning. For good aesthetics and function these have to be reconstructed accurately, which can be checked with X-rays. The treatment of midfacial fractures has been revolutionized over the last two decades. A stable three-dimensional reconstruction of the facial shape is now possible and the duration of treatment has shortened remarkably. The frequently occurring isolated fractures in the lateral part of the midface may be treated easily and effectively by semisurgical methods such as the Gillies procedure or hook-repositioning. (orig.)

  6. Tibial Plateau Fractures

    DEFF Research Database (Denmark)

    Elsøe, Rasmus

    This PhD thesis reported an incidence of tibial plateau fractures of 10.3/100,000/year in a complete Danish regional population. The results reported that patients treated for a lateral tibial plateau fracture with bone tamp reduction and percutaneous screw fixation achieved a satisfactory level...... with only the subgroup Sport significantly below the age matched reference population. The thesis reports a level of health related quality of life (Eq5d) and disability (KOOS) significantly below established reference populations for patients with bicondylar tibial plateau fracture treated with a ring...... fixator, both during treatment and at 19 months following injury. In general, the thesis demonstrates that the treatment of tibial plateau fractures are challenging and that some disabilities following these fractures must be expected. Moreover, the need for further research in the area, both with regard...

  7. Fracturing formations in wells

    Energy Technology Data Exchange (ETDEWEB)

    Daroza, R A

    1964-05-15

    This well stimulation method comprises introducing through the well bore a low-penetrating, dilatant fluid, and subjecting the fluid to sufficient pressure to produce fractures in the formation. The fluid is permitted to remain in contact with the formation so as to become diluted by the formation fluids, and thereby lose its properties of dilatancy. Also, a penetrating fluid, containing a propping agent suspended therein, in introduced into contact with the fractures at a pressure substantially reduced with respect to that pressure which would have been required, prior to the fracturing operation performed using the low-penetrating dilatant fluid. The propping agent is deposited within the fractures, and thereafter, fluid production is resumed from the fractured formation. (2 claims)

  8. Drug development: EU paediatric legislation, the European Medicines Agency and its Paediatric Committee--adolescents' melanoma as a paradigm.

    Science.gov (United States)

    Rose, Klaus; Senn, Stephen

    2014-01-01

    The European Medicines Agency (EMA) website lists all diseases that officially exist in adults only. The class waiver for juvenile melanoma was revoked in 2008 referring to US SEER statistics. This statistical justification is misleading. Melanoma in adolescents is much rarer than claimed by EMA/Paediatric Committee; < 1 ∕ 4 of adolescents with melanoma need systemic treatment; separate efficacy studies are neither medically justified nor feasible. The scarce adolescent patients should be allowed to participate in adult trials. To force companies to investigate them separately turns them into paediatric hostages, to adapt the term therapeutic orphans coined in 1968 by Shirkey. There are now five melanoma Paediatric Investigation Plans (PIPs). Probably none of the PIP-triggered clinical studies will ever be completed; we propose to call them ghost studies. An oncology research network considering a reasonable trial in melanoma, including adolescents, will compete for recruitment with the PIP-triggered trials designed by regulatory tunnel vision and sponsored by companies under EMA-imposed pressure. EMA/Paediatric Committee's territorial enthusiasm ("our patients") damages oncology research. Copyright © 2014 John Wiley & Sons, Ltd.

  9. Indications for admission, treatment and improved outcome of paediatric haematology/oncology patients admitted to a tertiary paediatric ICU.

    LENUS (Irish Health Repository)

    Owens, C

    2012-02-01

    BACKGROUND: Overall survival in paediatric cancer has improved significantly over the past 20 years. Treatment strategies have been intensified, and supportive care has made substantial advances. Historically, paediatric oncology patients admitted to an intensive care unit (ICU) have had extremely poor outcomes. METHODS: We conducted a retrospective cohort study over a 3-year period in a single centre to evaluate the outcomes for this particularly vulnerable group of patients admitted to a paediatric ICU. RESULTS: Fifty-five patients were admitted a total of 66 times to the ICU during the study period. The mortality rate of this group was 23% compared with an overall ICU mortality rate of 5%. 11\\/15 patients who died had an underlying haematological malignancy. Twenty-eight percent of children with organism-identified sepsis died. CONCLUSIONS: While mortality rates for paediatric oncology patients admitted to a ICU have improved, they are still substantial. Those with a haematological malignancy or admitted with sepsis are most at risk.

  10. Choosing a career in paediatrics: do trainees' views change over the first year of specialty training?

    Science.gov (United States)

    Goodyear, Helen M; Lakshminarayana, Indumathy; Wall, David; Bindal, Taruna

    2014-09-01

    To look at why a regional cohort of UK doctors chose a paediatric career and to ascertain views on their career near the end of training year one. A 20-item questionnaire was sent to all new regional paediatric specialty trainees. Three focus groups were held with trainees near the end of year one to elicit key themes. West Midlands Deanery, UK. Twenty-nine new regional paediatric specialty trainees in year one completed the questionnaire. A total of 15 trainees participated in the focus groups near the end of year one training. Reasons for choosing a paediatric career and factors which further influence career choice for trainees during their first specialty training year. Key influencing factors for choosing paediatrics were enjoying working with children and positive undergraduate experience of the specialty. All trainees had paediatrics as their first choice specialty and undertook a paediatric Foundation post. Near the end of year one, doubts were cast on career aspirations due to seeing middle grade colleagues struggling with work-life balance and a growing feeling that family came first. Senior trainees need to be aware that they act as powerful role models for their more junior colleagues and therefore have an influential role on how juniors perceive a paediatric career. Family friendly flexible working patterns in paediatrics are vital to retain junior trainees. All paediatric staff are role models and need to be enthusiastic, keen to teach and to promote a positive working environment.

  11. Current educational status of paediatric rheumatology in Europe: the results of PReS survey.

    Science.gov (United States)

    Demirkaya, E; Ozen, S; Türker, T; Kuis, W; Saurenmann, R K

    2009-01-01

    To understand the status of education and problems in paediatric rheumatology practice in Europe, through a survey. A 26-item questionnaire was conducted during the 14th Congress of the Paediatric Rheumatology European Society in Istanbul, 2007. Physicians who were practicing or studying within the field of paediatric rheumatology for at least one year were included in the survey. One hundred and twenty eight physicians, 79 paediatric rheumatologists (including 5 paediatric immunologists and 10 paediatric nephrologists), 34 paediatric rheumatology fellows and 15 adult rheumatologists completed the survey. The physicians were from: Europe 95 (81.9%), South America 12 (10.4%), Middle East 5 (4.3%), Asia 2 (1.7%), Africa 2 (1.7%). The duration of training for paediatric rheumatology ranged between 1-5 years (mean: 3.12+/-1.11). Sixty physicians scored their education as unsatisfactory and among those, 48 physicians were from Europe. Physicians reported good skills in the following items; intraarticular injections (83.3%); soft tissue injections (47.6%); evaluation of radiographs (67.5%); whereas competence in the evaluation of computed tomography/magnetic resonance imaging (30.5%); and musculoskeletal sonography (16.7%) was much lower. A need for improved basic science and rotations among relevant fields were specifically expressed. Being a relatively new speciality in the realm of paediatrics, paediatric rheumatology education at the European level needs to be further discussed, revised and uniformed.

  12. MMPI-2 profiles 23 years after paediatric mild traumatic brain injury.

    Science.gov (United States)

    Hessen, Erik; Anderson, Vicki; Nestvold, Knut

    2008-01-01

    Research suggest that post-concussive syndrome after mild traumatic brain injury (mTBI) is more common than chronic cognitive impairment. The aim of this study was to investigate very long-term outcome of subjective complaints after paediatric mTBI. The study was a follow-up 23 years after a prospective head injury study at a general hospital in Norway. Forty-one patients were assessed with the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) 23 years after sustaining mTBI as children. A good overall outcome was found with scores close to the normative mean, average length of education and normal employment rate. However, the children that sustained complicated mTBI showed slightly more pathological scores, typical for mild post-concussive syndrome. The most important predictors of poor outcome were skull fracture and a combination of post-traumatic amnesia > 30 minutes and EEG pathology within 24 hours after TBI. No influence of pre- and post-injury risk factors on current MMPI-2 profiles was evident. The results give support for the notion of potentially differential impact of uncomplicated vs complicated mTBI. The findings suggest that children and adolescents sustaining complicated mTBI may be at risk of developing subtle chronic symptoms typical of post-concussive syndrome.

  13. Paediatric cardiac intensive care unit: current setting and organization in 2010.

    Science.gov (United States)

    Fraisse, Alain; Le Bel, Stéphane; Mas, Bertrand; Macrae, Duncan

    2010-10-01

    Over recent decades, specialized paediatric cardiac intensive care has emerged as a central component in the management of critically ill, neonatal, paediatric and adult patients with congenital and acquired heart disease. The majority of high-volume centres (dealing with over 300 surgical cases per year) have dedicated paediatric cardiac intensive care units, with the smallest programmes more likely to care for paediatric cardiac patients in mixed paediatric or adult intensive care units. Specialized nursing staff are also a crucial presence at the patient's bedside for quality of care. A paediatric cardiac intensive care programme should have patients (preoperative and postoperative) grouped together geographically, and should provide proximity to the operating theatre, catheterization laboratory and radiology department, as well as to the regular ward. Age-appropriate medical equipment must be provided. An optimal strategy for running a paediatric cardiac intensive care programme should include: multidisciplinary collaboration and involvement with paediatric cardiology, anaesthesia, cardiac surgery and many other subspecialties; a risk-stratification strategy for quantifying perioperative risk; a personalized patient approach; and anticipatory care. Finally, progressive withdrawal from heavy paediatric cardiac intensive care management should be institutionalized. Although the countries of the European Union do not share any common legislation on the structure and organization of paediatric intensive care or paediatric cardiac intensive care, any paediatric cardiac surgery programme in France that is agreed by the French Health Ministry must perform at least '150 major procedures per year in children' and must provide a 'specialized paediatric intensive care unit'. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  14. Percutaneous Pin Fixation of Gartland Type I11 Supraconylar ...

    African Journals Online (AJOL)

    S G Lungu M.Med (Orth). Specialist Orthopaedic Surgeon. Zambian Italian Orthopaedic Hospital, Lusaka. Key words: Percutaneous, pin fixation, Gartland type Ill, supracondylar, fractures, and humerus. This was a prospective study of 40 children with severely displaced (Gartland Type 111) supracondylar fractures of the ...

  15. Computed tomograms of blowout fracture

    International Nuclear Information System (INIS)

    Ito, Haruhide; Hayashi, Minoru; Shoin, Katsuo; Hwang, Wen-Zern; Yamamoto, Shinjiro; Yonemura, Taizo.

    1985-01-01

    We studied 18 cases of orbital fractures, excluding optic canal fracture. There were 11 cases of pure blowout fracture and 3 of the impure type. The other 4 cases were orbital fractures without blowout fracture. The cardinal syndromes were diplopia, enophthalmos, and sensory disturbances of the trigeminal nerve in the pure type of blowout fracture. Many cases of the impure type of blowout fracture or of orbital fracture showed black eyes or a swelling of the eyelids which masked enophthalmos. Axial and coronal CT scans demonstrated: 1) the orbital fracture, 2) the degree of enophthalmos, 3) intraorbital soft tissue, such as incarcerated or prolapsed ocular muscles, 4) intraorbital hemorrhage, 5) the anatomical relation of the orbital fracture to the lacrimal canal, the trochlea, and the trigeminal nerve, and 6) the lesions of the paranasal sinus and the intracranial cavity. CT scans play an important role in determining what surgical procedures might best be employed. Pure blowout fractures were classified by CT scans into these four types: 1) incarcerating linear fracture, 2) trapdoor fracture, 3) punched-out fracture, and 4) broad fracture. Cases with severe head injury should be examined to see whether or not blowout fracture is present. If the patients are to hope to return to society, a blowout fracture should be treated as soon as possible. (author)

  16. Computed tomograms of blowout fracture

    Energy Technology Data Exchange (ETDEWEB)

    Ito, Haruhide; Hayashi, Minoru; Shoin, Katsuo; Hwang, Wen-Zern; Yamamoto, Shinjiro; Yonemura, Taizo

    1985-02-01

    We studied 18 cases of orbital fractures, excluding optic canal fracture. There were 11 cases of pure blowout fracture and 3 of the impure type. The other 4 cases were orbital fractures without blowout fracture. The cardinal syndromes were diplopia, enophthalmos, and sensory disturbances of the trigeminal nerve in the pure type of blowout fracture. Many cases of the impure type of blowout fracture or of orbital fracture showed black eyes or a swelling of the eyelids which masked enophthalmos. Axial and coronal CT scans demonstrated: 1) the orbital fracture, 2) the degree of enophthalmos, 3) intraorbital soft tissue, such as incarcerated or prolapsed ocular muscles, 4) intraorbital hemorrhage, 5) the anatomical relation of the orbital fracture to the lacrimal canal, the trochlea, and the trigeminal nerve, and 6) the lesions of the paranasal sinus and the intracranial cavity. CT scans play an important role in determining what surgical procedures might best be employed. Pure blowout fractures were classified by CT scans into these four types: 1) incarcerating linear fracture, 2) trapdoor fracture, 3) punched-out fracture, and 4) broad fracture. Cases with severe head injury should be examined to see whether or not blowout fracture is present. If the patients are to hope to return to society, a blowout fracture should be treated as soon as possible. (author).

  17. Outcome measures for clinical trials in paediatric IBD: an evidence-based, expert-driven practical statement paper of the paediatric ECCO committee

    NARCIS (Netherlands)

    Ruemmele, Frank M.; Hyams, Jeffrey S.; Otley, Anthony; Griffiths, Anne; Kolho, Kaija-Leena; Dias, Jorge Amil; Levine, Arie; Escher, Johanna C.; Taminiau, Jan; Veres, Gabor; Colombel, Jean-Frederic; Vermeire, Séverine; Wilson, David C.; Turner, Dan

    2015-01-01

    Objective Although paediatric-onset IBD is becoming more common, few medications have a registered paediatric indication. There are multiple hurdles to performing clinical trials in children, emphasising the importance of choosing an appropriate outcome measure, which can facilitate enrolment, and

  18. Extrapolation in the development of paediatric medicines: examples from approvals for biological treatments for paediatric chronic immune-mediated inflammatory diseases.

    Science.gov (United States)

    Stefanska, Anna M; Distlerová, Dorota; Musaus, Joachim; Olski, Thorsten M; Dunder, Kristina; Salmonson, Tomas; Mentzer, Dirk; Müller-Berghaus, Jan; Hemmings, Robert; Veselý, Richard

    2017-10-01

    The European Union (EU) Paediatric Regulation requires that all new medicinal products applying for a marketing authorisation (MA) in the EU provide a paediatric investigation plan (PIP) covering a clinical and non-clinical trial programme relating to the use in the paediatric population, unless a waiver applies. Conducting trials in children is challenging on many levels, including ethical and practical issues, which may affect the availability of the clinical evidence. In scientifically justified cases, extrapolation of data from other populations can be an option to gather evidence supporting the benefit-risk assessment of the medicinal product for paediatric use. The European Medicines Agency (EMA) is working on providing a framework for extrapolation that is scientifically valid, reliable and adequate to support MA of medicines for children. It is expected that the extrapolation framework together with therapeutic area guidelines and individual case studies will support future PIPs. Extrapolation has already been employed in several paediatric development programmes including biological treatment for immune-mediated diseases. This article reviews extrapolation strategies from MA applications for products for the treatment of juvenile idiopathic arthritis, paediatric psoriasis and paediatric inflammatory bowel disease. It also provides a summary of extrapolation advice expressed in relevant EMA guidelines and initiatives supporting the use of alternative approaches in paediatric medicine development. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  19. Radiological diagnosis of fractures

    International Nuclear Information System (INIS)

    Finlay, D.B.L.; Allen, M.J.

    1984-01-01

    This book is about radiology of fractures. While it contains sections of clinical features it is not intended that readers should rely entirely upon these for the diagnosis and management of the injured patient. As in the diagnosis and treatment of all medical problems, fracture management must be carried out in a logical step-by-step fashion - namely, history, examination, investigation, differential diagnosis, diagnosis and then treatment. Each section deals with a specific anatomical area and begins with line drawings of the normal radiographs demonstrating the anatomy. Accessory views that may be requested, and the indications for these, are included. Any radiological pitfalls for the area in general are then described. The fractures in adults are then examined in turn, their radiological features described, and any pitfalls in their diagnosis discussed. A brief note of important clinical findings is included. A brief mention is made of pediatric fractures which are of significance and their differences to the adult pattern indicated. Although fractures can be classified into types with different characteristics, in life every fracture is individual. Fractures by and large follow common patterns, but many have variations

  20. Spontaneous rib fractures.

    Science.gov (United States)

    Katrancioglu, Ozgur; Akkas, Yucel; Arslan, Sulhattin; Sahin, Ekber

    2015-07-01

    Other than trauma, rib fracture can occur spontaneously due to a severe cough or sneeze. In this study, patients with spontaneous rib fractures were analyzed according to age, sex, underlying pathology, treatment, and complications. Twelve patients who presented between February 2009 and February 2011 with spontaneous rib fracture were reviewed retrospectively. The patients' data were evaluated according to anamnesis, physical examination, and chest radiographs. The ages of the patients ranged from 34 to 77 years (mean 55.91 ± 12.20 years), and 7 (58.4%) were male. All patients had severe cough and chest pain. The fractures were most frequently between 4th and 9th ribs; multiple rib fractures were detected in 5 (41.7%) patients. Eight (66.7%) patients had chronic obstructive pulmonary disease, 2 (16.7%) had bronchial asthma, and 2 (16.7%) had osteoporosis. Bone densitometry revealed a high risk of bone fracture in all patients. Patients with chronic obstructive pulmonary disease or bronchial asthma had been treated with high-dose steroids for over a year. Spontaneous rib fracture due to severe cough may occur in patients with osteoporosis, chronic obstructive pulmonary disease, or bronchial asthma, receiving long-term steroid therapy. If these patients have severe chest pain, chest radiography should be performed to check for bone lesions. © The Author(s) 2015.

  1. Why ductile fracture mechanics

    International Nuclear Information System (INIS)

    Ritchie, R.O.

    1983-01-01

    Until recently, the engineering application of fracture mechanics has been specific to a description of macroscopic fracture behavior in components and structural parts which remain nominally elastic under loading. While this approach, termed linear elastic fracture mechanics, has been found to be invaluable for the continuum analysis of crack growth in brittle and high strength materials, it is clearly inappropriate for characterizing failure in lower strength ductile alloys where extensive inelastic deformation precedes and accompanies crack initiation and subsequent propagation. Accordingly, much effort has been devoted in recent years toward the development of nonlinear or ductile fracture mechanics methodology to characterize fracture behavior under elastic/plastic conditions; an effort which has been principally motivated by problems in nuclear industry. In this paper, the concepts of ductile (elastic/plastic) fracture mechanics are introduced and applied to the problem of both stationary and nonstationary cracks. Specifically, the limitations inherent in this approach are defined, together with a description of the microstructural considerations and applications relevant to the failure of ductile materials by fracture, fatigue, and creep

  2. Orbital wall fractures

    International Nuclear Information System (INIS)

    Iinuma, Toshitaka; Ishio, Ken-ichirou; Yoshinami, Hiroyoshi; Kuriyama, Jun-ichi; Hirota, Yoshiharu.

    1993-01-01

    A total of 59 cases of mild facial fractures (simple orbital wall fractures, 34 cases, other facial fractures, 25 cases) with the clinical suspects of orbital wall fractures were evaluated both by conventional views (Waters' and Caldwell views) and coronal CT scans. Conventional views were obtained, as an average, after 4 days and CT after 7 days of injuries. Both the medial wall and the floor were evaluated at two sites, i.e., anterior and posterior. The ethmoid-maxillary plate was also included in the study. The degree of fractures was classified as, no fractures, fractures of discontinuity, dislocation and fragmentation. The coronal CT images in bone window condition was used as reference and the findings were compared between conventional views and CT. The correct diagnosis was obtained as follows: orbital floor (anterior, 78%, posterior, 73%), medial orbital wall (anterior, 72%, posterior, 72%) and ethmoid-maxillary plate (64%). The false positive diagnosis was as follows: orbital floor (anterior only, 13%), medial orbital wall (anterior only, 7%) and ethmoid-maxillary plate (11%). The false negative diagnosis was as follows: orbital floor (anterior, 9%, posterior, 10%), medial orbital wall (anterior, 21%, posterior, 28%) and ethmoid-maxillary plate (21%). The results were compared with those of others in the past. (author)

  3. Chance Fracture Secondary to a Healed Kyphotic Compression Osteoporotic Fracture

    Directory of Open Access Journals (Sweden)

    Teh KK

    2009-11-01

    Full Text Available Chance fracture is an unstable vertebral fracture, which usually results from a high velocity injury. An elderly lady with a previously healed osteoporotic fracture of the T12 and L1 vertebra which resulted in a severe kyphotic deformity subsequently sustained a Chance fracture of the adjacent L2 vertebrae after a minor fall. The previously fracture left her with a deformity which resulted in significant sagittal imbalance therefore predisposing her to this fracture. This case highlights the importance of aggressive treatment of osteoporotic fractures in order to prevent significant sagittal imbalance from resultant (i.e. kyphotic deformity.

  4. Oral medicines for children in the European paediatric investigation plans.

    Directory of Open Access Journals (Sweden)

    Diana A van Riet-Nales

    Full Text Available INTRODUCTION: Pharmaceutical industry is no longer allowed to develop new medicines for use in adults only, as the 2007 Paediatric Regulation requires children to be considered also. The plans for such paediatric development called Paediatric Investigation Plans (PIPs are subject to agreement by the European Medicines Agency (EMA and its Paediatric Committee (PDCO. The aim of this study was to evaluate the key characteristics of oral paediatric medicines in the PIPs and the changes implemented as a result of the EMA/PDCO review. METHODS: All PIPs agreed by 31 December 2011 were identified through a proprietary EMA-database. PIPs were included if they contained an agreed proposal to develop an oral medicine for children 0 to 11 years. Information on the therapeutic area (EMA classification system; target age range (as defined by industry and pharmaceutical characteristics (active substance, dosage form(s as listed in the PIP, strength of each dosage form, excipients in each strength of each dosage form was extracted from the EMA website or the EMA/PDCO assessment reports. RESULTS: A hundred and fifty PIPs were included corresponding to 16 therapeutic areas and 220 oral dosage forms in 431 strengths/compositions. Eighty-two PIPs (37% included tablets, 44 (20% liquids and 35 (16% dosage forms with a specific composition/strength that were stored as a solid but swallowed as a liquid e.g. dispersible tablets. The EMA/PDCO review resulted in an increase of 13 (207 to 220 oral paediatric dosage forms and 44 (387 to 431 dosage forms with a specific composition/strength. For many PIPs, the target age range was widened and the excipient composition and usability aspects modified. CONCLUSION: The EMA/PDCO review realized an increase in the number of requirements for the development of oral dosage forms and a larger increase in the number of dosage forms with a specific composition/strength, both targeting younger children. Changes to their pharmaceutical

  5. A Rare Nasal Bone Fracture: Anterior Nasal Spine Fracture

    Directory of Open Access Journals (Sweden)

    Egemen Kucuk

    2014-04-01

    Full Text Available Anterior nasal spine fractures are a quite rare type of nasal bone fractures. Associated cervical spine injuries are more dangerous than the nasal bone fracture. A case of the anterior nasal spine fracture, in a 18-year-old male was presented. Fracture of the anterior nasal spine, should be considered in the differential diagnosis of the midface injuries and also accompanying cervical spine injury should not be ignored.

  6. Fracture characteristics in Japanese rock

    International Nuclear Information System (INIS)

    Ijiri, Yuji; Sawada, Atsushi; Akahori, Kuniaki

    1999-11-01

    It is crucial for the performance assessment of geosphere to evaluate the characteristics of fractures that can be dominant radionuclide migration pathways from a repository to biosphere. This report summarizes the characteristics of fractures obtained from broad literature surveys and the fields surveys at the Kamaishi mine in northern Japan and at outcrops and galleries throughout the country. The characteristics of fractures described in this report are fracture orientation, fracture shape, fracture frequency, fracture distribution in space, transmissivity of fracture, fracture aperture, fracture fillings, alteration halo along fracture, flow-wetted surface area in fracture, and the correlation among these characteristics. Since granitic rock is considered the archetype fractured media, a large amount of fracture data is available in literature. In addition, granitic rock has been treated as a potential host rock in many overseas programs, and has JNC performed a number of field observations and experiments in granodiorite at the Kamaishi mine. Therefore, the characteristics of fractures in granitic rock are qualitatively and quantitatively clarified to some extent in this report, while the characteristics of fractures in another rock types are not clarified. (author)

  7. Aspects of modern fracture statistics

    International Nuclear Information System (INIS)

    Tradinik, W.; Pabst, R.F.; Kromp, K.

    1981-01-01

    This contribution begins with introductory general remarks about fracture statistics. Then the fundamentals of the distribution of fracture probability are described. In the following part the application of the Weibull Statistics is justified. In the fourth chapter the microstructure of the material is considered in connection with calculations made in order to determine the fracture probability or risk of fracture. (RW) [de

  8. Fracture Phenomena in Amorphous Selenium

    DEFF Research Database (Denmark)

    Lindegaard-Andersen, Asger; Dahle, Birgit

    1966-01-01

    Fracture surfaces of amorphous selenium broken in flexure at room temperature have been studied. The fracture velocity was found to vary in different regions of the fracture surface. Peculiar features were observed in a transition zone between fast and slower fracture. In this zone cleavage steps...

  9. Treatment of pediatric femoral shaft fractures by stainless steel and titanium elastic nail system: A randomized comparative trial.

    Science.gov (United States)

    Gyaneshwar, Tank; Nitesh, Rustagi; Sagar, Tomar; Pranav, Kothiyal; Rustagi, Nitesh

    2016-08-01

    Literature suggests that the lower modulus of elasticity of titanium makes it ideal for use in children compared with stainless steel. Better fracture stability was observed in association with titanium nails on torsional and axial compression testing. However, stainless steel nails are stiffer than titanium counterparts, which may provide a rigid construct when fixing paediatric femoral shaft fractures. Complications have been observed more frequently by various researchers when titanium nails are used for fracture fixation in patients with increasing age or weight. The concept of this study was to compare the functional outcome after internal fixation with titanium elastic nail system and stainless steel elastic nail system in paediatric femoral shaft fractures. The study was conducted on 34 patients admitted in the department of orthopaedics, LLRM Medical College & SVBP Hospital, Meerut, India from January 2013 to August 2014. We included patients aged 5-12 years with fracture of the femoral shaft, excluding compound fractures, pathological fractures and other lower limb fractures. Patients were treated by titanium (n=17) or stainless steel (n=17) elastic nail system and followed up for one year. The clinical parameters like range of motion at hip and knee joints, time to full weight bearing on the operated limb and radiological parameters like time to union were compared between two groups. A special note was made of intra- and post-operative complications. Functional outcomes were analysed according to Flynn criteria. Based on the Flynn criteria, 59% of patients had excellent results, 41% had satisfactory results, and no one showed poor results. There was no clinically significant difference between the two groups with respect to time to union and full weight bearing. But the incidence of puncture of the opposite cortex while inserting the nail and trying to advance it through the diaphysis during operation is greatly different. Only one such case was observed

  10. Vertebral Compression Fractures

    Science.gov (United States)

    ... and monitored to avoid putting pressure on the ribs that can cause new fractures. Surgical Procedures • When there is severe incapacitating pain • When healing is delayed or when bone fragments ...

  11. Elevated temperature fracture mechanics

    International Nuclear Information System (INIS)

    Tomkins, B.

    1979-01-01

    The application of fracture mechanics concepts to cracks at elevated temperatures is examined. Particular consideration is given to the characterisation of crack tip stress-strain fields and parameters controlling crack extension under static and cyclic loads. (author)

  12. Stress fractures in athletes

    International Nuclear Information System (INIS)

    Kirschberger, R.; Henning, A.; Graff, K.H.

    1984-01-01

    The early exclusion of the presence of a stress fracture may be decisive for the success of an athlete. Scintigraphy with a bone-seeking radiopharmaceutical is suitable for the early detection of stress lesions. Of 30 athletes, fractures were demonstrated in 17 whereas in 6 they were excluded. We found most fractures in the tarsal bones such as os naviculare pedis, ossa cuneiformia and talus. The type of sport engaged in appears to be an important factor in determining the location of the fracture. Scintiphotos were taken in several views using region of interest techniques and two phase-scintigraphy. This method is considered to be useful for localization and follow-up of skeletal stress lesions as well as for differential diagnosis. (orig.) [de

  13. Stress fractures in athletes

    Energy Technology Data Exchange (ETDEWEB)

    Kirschberger, R; Henning, A; Graff, K H

    1984-12-01

    The early exclusion of the presence of a stress fracture may be decisive for the success of an athlete. Scintigraphy with a bone-seeking radiopharmaceutical is suitable for the early detection of stress lesions. Of 30 athletes, fractures were demonstrated in 17 whereas in 6 they were excluded. We found most fractures in the tarsal bones such as os naviculare pedis, ossa cuneiformia and talus. The type of sport engaged in appears to be an important factor in determining the location of the fracture. Scintiphotos were taken in several views using region of interest techniques and two phase-scintigraphy. This method is considered to be useful for localization and follow-up of skeletal stress lesions as well as for differential diagnosis.

  14. Fatigue and insufficiency fractures

    International Nuclear Information System (INIS)

    Lodwick, G.S.; Rosenthal, D.I.; Kattapuram, S.V.; Hudson, T.M.

    1987-01-01

    The incidence of stress fracture is increasing. In our younger society this is due largely to a preocupation with physical conditioning, but in our elderly population it is due to improved recognition and better methods of detection and diagnosis. Stress fracture of the elderly is an insufficiency fracture which occurs in the spine, the pelvis, the sacrum and other bones afflicted with disorders which cause osteopenia. Stress fracture is frequently misdiagnosed as a malignant lesion of bone resulting in biopsy. Scintiscanning provides the greatest frequency of detection, while computed tomography often provides the definitive diagnosis. With increased interest and experience a better insight into the disease has been achieved, and what was once thought of as a simple manifestation of mechanical stress is now known to be an orderly, complex pattern of physiological changes in bone which conform to a model by Frost. The diffuse nature of these changes can be recognized by scintigraphy, radiography and magnetic resonance imaging. 27 refs.; 8 figs

  15. Ontology of fractures

    Science.gov (United States)

    Zhong, Jian; Aydina, Atilla; McGuinness, Deborah L.

    2009-03-01

    Fractures are fundamental structures in the Earth's crust and they can impact many societal and industrial activities including oil and gas exploration and production, aquifer management, CO 2 sequestration, waste isolation, the stabilization of engineering structures, and assessing natural hazards (earthquakes, volcanoes, and landslides). Therefore, an ontology which organizes the concepts of fractures could help facilitate a sound education within, and communication among, the highly diverse professional and academic community interested in the problems cited above. We developed a process-based ontology that makes explicit specifications about fractures, their properties, and the deformation mechanisms which lead to their formation and evolution. Our ontology emphasizes the relationships among concepts such as the factors that influence the mechanism(s) responsible for the formation and evolution of specific fracture types. Our ontology is a valuable resource with a potential to applications in a number of fields utilizing recent advances in Information Technology, specifically for digital data and information in computers, grids, and Web services.

  16. Paediatric cardiopulmonary resuscitation training program in Latin-America: the RIBEPCI experience

    OpenAIRE

    L?pez-Herce, Jes?s; Matamoros, Martha M.; Moya, Luis; Almonte, Enma; Coronel, Diana; Urbano, Javier; Carrillo, ?ngel; del Castillo, Jimena; Menc?a, Santiago; Moral, Ram?n; Ordo?ez, Flora; S?nchez, Carlos; Lagos, Lina; Johnson, Mar?a; Mendoza, Ovidio

    2017-01-01

    Background To describe the design and to present the results of a paediatric and neonatal cardiopulmonary resuscitation (CPR) training program adapted to Latin-America. Methods A paediatric CPR coordinated training project was set up in several Latin-American countries with the instructional and scientific support of the Spanish Group for Paediatric and Neonatal CPR. The program was divided into four phases: CPR training and preparation of instructors; training for instructors; supervised tea...

  17. Managing guidelines to support parents with the hospitalisation of their child in a private paediatric unit

    OpenAIRE

    2008-01-01

    The purpose of this research study was to describe managerial guidelines to support parents with the hospitalisation of their child in a private paediatric unit. The study explored and described: · the nursing care experiences of parents regarding the hospitalisation of their child in a paediatric unit; · managerial guidelines to support parents with their lived experiences of their child’s hospitalisation in a private paediatric unit. To achieve the purpose and the objectives of the research...

  18. Paediatric radiology. 2. enl. and tot. rev. ed.

    International Nuclear Information System (INIS)

    Benz-Bohm, G.

    2005-01-01

    This book presents a current, comprehensive and clearly written introduction to the often-neglected field of paediatric radiology, from important aspects of radiation protection to the specific anatomic features of the growing skeleton and the special anatomy of the thorax and abdomen of newborns and infants. Special knowledge is imparted on the radiology of trauma effects in infant age and the 'battered child syndrome'. The diseases and findings are presented in an organ-specific and topographic manner. There are special chapters on sonography, CT and MRT in infants. The structure of the book serves two purposes. First, the reader can obtain information on specific diseases; secondly, the particular features of examination techniques and the specifics of paediatric radiology are presented. (orig.) [de

  19. Realities of paediatric pharmacotherapy in the developing world.

    Science.gov (United States)

    Hoppu, Kalle; Sri Ranganathan, Shalini; Dodoo, Alex N O

    2011-08-01

    Diseases causing high mortality in children under 5 years of age in resource limited settings (RLS) could be treated if children in these countries had access to existing medicines. It took 30 years before the WHO Essential Medicines List (EML) considered the issue of medicines for children, with the first EML for children being published in 2007. Recent data indicate that less than half of the key paediatric essential medicines are available in countries of sub-Saharan Africa. Problems include substandard medicines, irrational use of medicines, inefficiency and even possible corruption in pharmaceutical management systems. These are global issues which affect RLS most. Clinical trials in developing countries for the benefit of children are needed but challenging in several ways. In this review, the authors will consider the following areas where progress could improve paediatric pharmacotherapy in RLS: registration and regulation of medicines, rational use of medicines, clinical trials in children and restriction of corruption in pharmaceutical management systems.

  20. Demographics of paediatric renal replacement therapy in Europe

    DEFF Research Database (Denmark)

    Chesnaye, Nicholas; Bonthuis, Marjolein; Schaefer, Franz

    2014-01-01

    BACKGROUND: The ESPN/ERA-EDTA Registry collects data on European children with end-stage renal disease receiving renal replacement therapy (RRT) who are listed on national and regional renal registries in Europe. In this paper we report on the analysis of demographic data collected from 2009...... to 2011. METHODS: Data on primary renal disease, incidence, prevalence, 4-year survival, transplantation rate and causes of death in paediatric patients receiving RRT were extracted from the ESPN/ERA-EDTA Registry for 37 European countries. RESULTS: The incidence of RRT in paediatric patients in Europe...... during the study period was 5.5 cases per million age-related population (pmarp) in patients aged 0-14 years and varied markedly between countries (interquartile range 3.4-7.0 years). The prevalence of RRT was 27.9 pmarp and increased with age, with 67 % of prevalent patients living with a functioning...