PURPOSE OF THE STUDY: Pelvic avulsion fractures in children are rare and usually associated with sports. The study aimed to evaluate the epidemiology, complications, and displacement cutoff value for surgical treatment. MATERIAL AND METHODS: In a retrospective study (2007-2022), we used a group of 201 boys and 20 girls (p < 0.0001). The mean age of boys was 14.9 ± 1.7, and 14.0 ± 1.9 years for girls (p = 0.0129). Injuries included 86 anterior superior iliac spine (ASIS), 83 anterior inferior iliac spine (AIIS), 28 ischial tuberosity (ITU), 13 iliac crest, nine reflected head of the rectus femoris avulsions, and two ipsilateral ASIS + AIIS avulsions. The displacement cutoff value was determined using logistic regression. Complications were assessed using Cox regression and Kaplan-Meier plots. RESULTS: The mean incidence of avulsions was 21 per 1,000,000 children per year. The highest prevalence of osteosynthesis was in ITU (10 out of 28, 35.71%); iliac crest and reflexed head avulsions were treated conservatively. Running was related to the highest risk of ASIS, football for AIIS, and gymnastics for ITU. Most avulsions occurred in September, the fewest in July. Displacement cutoff values were calculated as 10.5 mm for ASIS, 9.5 mm for AIIS, and 14.5 mm for ITU. The most common healing complication was distraction 31 (14.0%), refracture in 2 ITU and non-union in 1 ITU; ITU complications were treated with osteosynthesis. According to the Cox regression, the following items significantly affected outcomes: fracture type (p < 0.0001), early verticalization (p = 0.0062), and initial displacement (p < 0.0001). DISCUSSION: Our study had several limitations, such as it was retrospective, there was a loss of patients from follow-up, and a lack of functional evaluations, for example, using Majeed's score modified for pediatric patients. The positives of the study included a relatively large group of patients from multiple hospitals, the use of logistic regression to determine displacement values to help differentiate between OS and conservative treatment, the inclusion of fracture incidence data, and the inclusion of patients with both surgical and conservative treatment. CONCLUSIONS: In the case of ASIS and AIIS avulsions, osteosynthesis can be considered for displacements ≥ 1 cm and ≥ 1.5 cm for ITU avulsions. Early verticalization was associated with a lower risk of healing complications in distraction injuries.
- Klíčová slova
- avulsion injury, complication., epidemiology, multicentric study, pediatric pelvic fracture,
- MeSH
- avulzní fraktury * epidemiologie chirurgie MeSH
- dítě MeSH
- incidence MeSH
- lidé MeSH
- mladiství MeSH
- pánevní kosti * zranění chirurgie MeSH
- retrospektivní studie MeSH
- sportovní úrazy * epidemiologie MeSH
- traumatologická centra statistika a číselné údaje MeSH
- vnitřní fixace fraktury metody MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- multicentrická studie MeSH
PURPOSE: To evaluate the effect of vitamin D on the speed and quality of pediatric fracture healing. METHODS: A 4-year prospective study of healthy children with shaft fractures of the forearm bones (treated with minimally invasive osteosynthesis) or femur (treated by traction or by minimally invasive osteosynthesis). All children had their vitamin D levels examined four times-at the time of the injury, 1, 3, and 5 months after the injury. Also, all children underwent radiograph follow-ups (same time as blood tests) to evaluate fracture healing. Children were, in the beginning, blindly divided into two similarly sized groups-one group was orally administered cholecalciferol throughout the follow-up, the second group was not, and we compared those groups. RESULTS: Altogether, 63 children were included in the study-36 supplemented and 27 non-supplemented. In supplemented children, the vitamin D levels increased statistically significantly during the follow-up period, in contrast to the non-supplemented group. The fracture healing on radiographs was also statistically significantly faster and better in the supplemented group. When we divided children according to fracture type, we observed statistically significantly better fracture healing in children with forearm fractures in the supplemented group for the whole study period. In children with femoral fractures, the healing in the supplemented group was statistically significantly better after 3 months; however, after 1 and 5 months, the difference was not statistically significant. CONCLUSIONS: Based on our results, we recommend vitamin D testing and administration for children treated for forearm and femoral fractures. LEVEL OF EVIDENCE: Level I.
- Klíčová slova
- Vitamin D, children, fracture healing, healing quality, pediatric fracture, vitamin D supplementation,
- Publikační typ
- časopisecké články MeSH
PURPOSE: The aim of the study is to evaluate the use of ultrasound imaging in diagnostics of Monteggia lesion in children where conventional radiographs and the use of the radiocapitellar line fail to provide an accurate diagnosis. METHODS: Prospective diagnostic study of 70 patients treated between May 2018 and July 2021 in a pediatric level 1 trauma center. In 20 patients with the confirmed radiographic diagnosis of Monteggia lesion, an ultrasound of the humeroradial joint was performed to determine signs of both normal and dislocated elbow joint. In 36 patients with suspected humeroradial dislocation on plain radiographs, ultrasound imaging was performed to determine the definitive diagnosis. Overall, 14 patients with elbow joint injury other than humeroradial dislocation were excluded from the study. RESULTS: The "double-hump sign" and the "congruency sign" were determined as normal findings on ultrasound of the humeroradial joint. These signs were applied to patients with unclear findings on radiographs. In three patients, the dislocation of the humeroradial joint was confirmed by ultrasound. In two patients, "defect in congruency sign" was seen during reduction despite normal radiographs, which required re-reduction. In 31 patients, dislocation of the humeroradial joint was refuted. In 34 out of the 36 patients, the diagnosis determined by ultrasound was confirmed in follow-up. Two patients did not attend the follow-up examination. CONCLUSION: Ultrasound imaging is an accessible, non-invasive, and dynamic point-of-care method that can be applied in children suffering from suspected humeroradial dislocation and/or subluxation. LEVEL OF EVIDENCE: Level III-diagnostic study.
- Klíčová slova
- Monteggia, Ultrasound, child, elbow, sonography,
- Publikační typ
- časopisecké články MeSH
The aim of the study was a qualitative anatomical analysis of the macroscopic features of the surface of the calcaneal tuberosity, of the architecture of its cancellous bone and histological structure of the whole region. Dry human bones and pathological dissection material 24-36 h post mortem were used in the study. On the tuberosity, the variability of its surface relief and the two borders between the superior, middle and inferior facets were studied. More frequent medial declination of the inferior line, corresponding to the distal circumference of the Achilles tendon attachment, was found. Two systems of expressive condensation of cancellous bone just below the surface of the calcaneal tuberosity were described. In the histological part of the study, the distribution and different thickness of the fibrous cartilage layer covering the attachment region of Achilles tendon, the bottom of retro-calcaneal bursa and the whole surface of the calcaneal tuberosity were described. The functional and clinical relevance of results obtained are evaluated from the point of view of disciplines dealing with the pathology and surgery of the heel region. The relationships of official anatomical terms and a wide spectrum of clinical synonyms designating this region are discussed.
