Objective: The exploration of epidemiological patterns of trauma in underage patients serves as a critical reference for the prevention and treatment of trauma in minors. Methods: Data from all cases at the trauma cen...Objective: The exploration of epidemiological patterns of trauma in underage patients serves as a critical reference for the prevention and treatment of trauma in minors. Methods: Data from all cases at the trauma center of the First Hospital of Lanzhou University were collected for the period from November 1, 2020, to October 31, 2023. Cases involving underage trauma patients with complete and quality-controlled data were selected for retrospective analysis. The data analyzed included age, gender, time of trauma, cause of trauma, and major injured body parts. Results: A total of 4568 underage trauma patients were identified, comprising 3093 males and 1475 females, resulting in a male-to-female ratio of 2.10:1. Trauma incidents were most prevalent between April and October, with fewer occurrences in November and December. Daily trauma incidents peaked between 18:00 and 22:00, while fewer incidents were recorded from 00:00 to 08:00. Among children aged 0 to 6 years, the highest number of injuries was observed. Falls were the predominant cause of trauma, accounting for 52.78%. In terms of the main injured body parts, the limbs/skin were the most affected (60.22%), followed by the head/neck region (32.03%). A statistically significant disparity was observed in the association between distinct causes of trauma and major injured body parts (P Conclusion: Trauma among minors occurs more frequently in males than in females, with the highest incidence observed among preschool-aged children. Falls are the primary cause of these injuries. Strengthening fall prevention measures, particularly for preschool-aged children, along with enhancing their self-protective awareness and traffic safety consciousness, can effectively reduce the incidence of injuries among minors, thereby safeguarding their health and well-being.展开更多
Importance:Reported coronavirus disease 2019(COVID-19)pandemic effects on pediatric trauma have been variable.Objective:We investigated the characteristics of pediatric trauma including alcohol use during the pandemic...Importance:Reported coronavirus disease 2019(COVID-19)pandemic effects on pediatric trauma have been variable.Objective:We investigated the characteristics of pediatric trauma including alcohol use during the pandemic at our urban trauma center.Methods:The trauma database of our adult level 1 trauma center was queried for all pediatric(age≤18 years)patients presenting between March 1,2020,and October 30,2020.Data from 2017 to 2019 served as a control.Variables analyzed included demographics,mechanisms,injury severity,hospitalization characteristics,and positive blood alcohol.Results:Pandemic pediatric trauma volumes increased by 67.5%(330/year vs.197/year).Pandemic patients were younger(median age 13 vs.14 years,P=0.011),but similar in gender,ethnicity,severity,hospital length of stay,mortality,and rates of penetrating injury.Falls doubled(79/year vs.34/year)and shifted away from high falls>6 meters(0%vs.7.9%)to moderate falls 1–6 meters(58.2%vs.51.5%)(P=0.028).Transportation injury rates were similar however mechanisms shifted from motor vehicle crashes(−13.5%)towards recreational vehicles including motorcycles(+2.1%),all-terrain vehicles(+8.6%),and bicycles(+3.8%)(P=0.018).Pediatricpositive blood alcohol was significantly higher(11.2%vs.5.1%,P<0.001),especially for ages 14–18 years(21.7%vs.9.5%,P<0.001).Interpretation:Pediatric trauma volumes during the COVID-19 pandemic increased.Pandemic patients had more recreational vehicle injuries and higher rates of positive blood alcohol.This suggests an increased need for alcohol assessment and targeted interventions in the pediatric population during pandemics or periods of school closures.展开更多
Introduction: Facial fractures are uncommon injuries in children. Pediatric maxillofacial fractures constitute 1% to 15% of all facial fractures, but show different clinical features when compared with adult patients....Introduction: Facial fractures are uncommon injuries in children. Pediatric maxillofacial fractures constitute 1% to 15% of all facial fractures, but show different clinical features when compared with adult patients. Worldwide, the major causes of fractures in children are accidents, falls, violence, and sports- related accidents. Facial trauma in children may result in injury to the facial growth centers, leading to subsequent developmental abnormalities in the injured area. Patients & Methods: Data of pediatric and adolescent patients (0 - 17 years), with a history of trauma, has been compiled over a period of 6 years. History, clinical and radiographic data records were analyzed. Compilation was done in the following categories;age and sex distribution, etiology, site of trauma and associated soft tissue injuries were recorded. The treatment rendered has also been mentioned. Results: A total of 340 patient records were assessed. Demographic data, etiology, type of fracture, associated injury and treatment rendered were recorded. It was found that males (54.7%) were more frequently affected than females (45.3%). Incidence of trauma was more in children belonging to the pre-school age group (38.5%) and the most common etiology was sports-related injuries (43.8%). Dentoalveolar fractures were the most common type (58.5%) of fractures seen in the patients. Most of the patients were managed by conservative treatment (35%) or closed reduction (48%), while a few required open reduction (7.9%). Conclusion: It is felt that this data will be useful in determining the pattern and etiology of maxillofacial trauma in pediatric patients in an Indian setting. Additionally, an outline of the treatment plan in different types of fractures is also summarized.展开更多
AIM:To evaluate the predictive value of pediatric penetrating ocular trauma score(POTS)on the visual outcome in children with open globe injury.METHODS:A retrospective study in 90 children(60 males and 30 females)aged...AIM:To evaluate the predictive value of pediatric penetrating ocular trauma score(POTS)on the visual outcome in children with open globe injury.METHODS:A retrospective study in 90 children(60 males and 30 females)aged 1-15 y(average,7.48±2.86 y)with penetrating ocular trauma was performed.Each patient’s POTS was calculated.The effects of POTS on final visual acuity(FVA)were examined.Correlation between factors affecting POTS and the FVA was established.RESULTS:All patients presented with single-eye trauma.The follow-up time was 3-21 mo(average,10.23±3.54 mo).Among the 90 cases of penetrating wounds,71 eyes(78.89%)were injured in Zone I(wound involvement limited to the cornea,including the corneoscleral limbus),17 eyes(18.89%)were injured in Zone II(wound involving the sclera and no more posterior than 5 mm from the corneoscleral limbus),and 2 eyes(2.22%)were injured in Zone III(wound involvement posterior to the anterior 5 mm of the sclera).Analysis of POTS and FVA showed important correlation between them(r=0.414,P=0.000).Initial visual acuity(P=0.00),age(P=0.02),injury location(P=0.002),traumatic cataract(P=0.00),vitreous hemorrhage(P=0.027),retinal detachment(P=0.003),and endophthalmitis(P=0.03)were found to be statistically significant factors for the FVA outcome.CONCLUSION:Ocular trauma presents serious consequences and poor prognosis in children.The POTS may be a reliable prognostic tool in children with open globe injury.展开更多
AIM: To evaluate the predictive value and applicability of Ocular Trauma Score(OTS) and Pediatric Ocular Trauma Score(POTS) for closed and open globe injuries in the pediatric group.METHODS: A retrospective study of c...AIM: To evaluate the predictive value and applicability of Ocular Trauma Score(OTS) and Pediatric Ocular Trauma Score(POTS) for closed and open globe injuries in the pediatric group.METHODS: A retrospective study of closed and open globe injuries in children age of 0-18-year-old between 2012-2019 was conducted.Medical records were collected,and injuries were classified using Birmingham Eye Trauma Terminology System(BETTS).The predictive value and applicability of both OTS and POTS to final visual acuity(VA) were analyzed.RESULTS: Of 84 patients,59(70.2%) presented with closed globe injuries(CGI) and 25(29.8%) with open globe injuries(OGI).The mean of initial VA was 0.832±0.904 log MAR.OTS and POTS was calculated.Initial VA(P<0.001) and traumatic cataract(P<0.001) were significantly associated with visual outcome,followed by organic/unclean wound (P=0.001),delay of surger y(P=0.001),iris prolapse(P=0.003),and globe rupture(P=0.008).A strong correlation between OTS and POTS and final VA(r=-0.798,P<0.001;r=-0.612,P<0.001) was found.OTS was more applicable in all age group of pediatric and in contrast to POTS,it was designed for 0-15 years old.POTS requires eleven parameters and OTS six parameters.Even though initial VA was not available,we could still calculate into POTS equation.CONCLUSION: OTS and POTS are highly predictive prognostic tools for final VA in CGI and OGI's in children.展开更多
BACKGROUND Open long bone fractures are a major concern for pediatric patients due to the risk of surgical site infection(SSI).Early studies have recommended irrigation and debridement of open fractures within 6 hours...BACKGROUND Open long bone fractures are a major concern for pediatric patients due to the risk of surgical site infection(SSI).Early studies have recommended irrigation and debridement of open fractures within 6 hours-8 hours for the prevention of SSI.According to the American College of Surgeons(ACS)Best Practice Guidelines,in 2015,irrigation and debridement should be done within 24 hours.AIM To identify whether early irrigation and debridement,within 8 hours,vs late,between 8 hours and 24 hours,for pediatric open long bone fractures impacts rate of SSI.METHODS Using retrospective data review from the National Trauma Data Bank,Trauma Quality Improvement Project(TQIP)of 2019.TQIP database is own by the ACS and it is the largest database for trauma quality program in the world.Propensity matching analysis was performed for the study.RESULTS There were 390 pediatric patients with open long bone fractures who were incl-uded in the study.After completing propensity score matching,we had 176 patients in each category,irrigation and debridement within 8 hours and irrigation and debridement between 8 hours and 24 hours.We found no significant differences between each group for the rate of deep SSI which was 0.6%for patients who received surgical irrigation and debridement within 8 hours and 1.1%for those who received it after 8 hours[adjusted odd ratio(AOR):0.5,95%CI:0.268-30.909,P>0.99].For the secondary outcomes studied,in terms of length of hospital stay,patients who received irrigation and debridement within 8 hours stayed for an average of 3.5 days,and those who received it after 8 hours stayed for an average of 3 days,with no significant difference found,and there were also no sig-nificant differences found between the discharge dispositions of the patients.CONCLUSION Our findings support the recommendation for managing open long bone fractures from the ACS:Complete surgical irrigation and debridement within 24 hours.展开更多
Traumatic cataract resulting from open- or closed-globe ocular trauma is one of the most common causes of blindness. Visual outcome is unpredictable because this is not determined solely by the lens. There is a lack o...Traumatic cataract resulting from open- or closed-globe ocular trauma is one of the most common causes of blindness. Visual outcome is unpredictable because this is not determined solely by the lens. There is a lack of a standard classification, investigations, and treatment guidelines related to the outcome, with considerable debate regarding predictive models. We review the predictors of visual outcome following surgical treatment of traumatic cataracts, which may act as a guide to clinicians.展开更多
Isolated duodenal perforation(IDP)in pediatric trauma is rarely reported.Since most of the children with blunt trauma are managed expectantly,timely diagnosis is imperative to avoid morbidity and mortality.We report a...Isolated duodenal perforation(IDP)in pediatric trauma is rarely reported.Since most of the children with blunt trauma are managed expectantly,timely diagnosis is imperative to avoid morbidity and mortality.We report a case of IDP and emphasize on certain specific clinical features indicating possibility of duodenal injury.We also stress upon the role of early contrast-enhanced computerized tomography(CECT)in such cases.展开更多
Aim:The utilization of free-tissue transfer secondary to traumatic lower extremity defects in the pediatric population is scarcely described.Factors include microsurgeon inexperience,inadequate center resources,and fe...Aim:The utilization of free-tissue transfer secondary to traumatic lower extremity defects in the pediatric population is scarcely described.Factors include microsurgeon inexperience,inadequate center resources,and fear of historically described poor surgical outcomes.The aim of this study is to investigate more recent articles describing free-flap microsurgical reconstruction for these defects.Methods:A systematic review of the literature was conducted through the online databases PubMed,Embase,and Web of Science,examining for articles with at least 20 subjects utilizing free-tissue transfer for soft-tissue defects of the pediatric(aged 18 and younger)lower extremity following traumatic etiology since 2005.Outcomes included flap failure,return to the operating room,and functional status,where available.Results:Seven studies were deemed appropriate for inclusion,with a total of 243 flaps included.Motor vehicle and motorcycle accidents were greater than 75%of total etiology.Most defects involved the foot or ankle(65.1%).In total,perforator flaps compromised the majority of flaps(54%),with the most common being the anterolateral thigh,the scapular/parascapular,and deep inferior epigastric flaps.Less common perforators included the groin flap,tensor fascia lata,radial forearm,lateral arm,and thoracodorsal perforator flap.Muscle-based flaps were less common(46%),with the latissimus dorsi and rectus muscle flaps composing the majority.The most commonly used recipient vessel was the anterior tibialis(49.5%)and posterior tibialis vessels(45.3%).Most studies performed reconstruction within 7-10 days of presentation.There was a cumulative 6.5%flap failure rate.Conclusion:Free tissue transfer for pediatric lower extremity trauma is an important tool that likely leads to powerful outcomes.Recent trends indicate increasing usage of perforator flaps.This study shows that based on existing data,free flap utilization for pediatric patients is an adequate modality for repair,and may warrant greater consideration moving forward.展开更多
Purpose： Ocular trauma is one of the most common causes of acquired blindness in children. It measures about 8%-14% of total childhood injuries. This study aims to determine the epidemiological profile of ocular trau...Purpose： Ocular trauma is one of the most common causes of acquired blindness in children. It measures about 8%-14% of total childhood injuries. This study aims to determine the epidemiological profile of ocular trauma in the pediatric age group attending a tertiary hospital in northern India. Methods： A retrospective study was conducted in our hospital between June 2014 to July 2015 and all the children aged 0-16 years presenting with ocular trauma in eye outpatient department and emergency were enrolled in the study. Various epidemiological parameters like age, sex distribution, duration of presentation, mode of injury, type of injury and final visual outcome were analyzed. Results： Of total 357 patients, 271 （76%） were below the age of 12 years： 41.1% of children with ocular trauma belonged to age group 2-6 years. The male to female ratio was 2.9：1. Out of total patients, 242 （67.8%） presented with closed globe injury. Among the closed globe injury, the history of fall was present in about 35% of children, followed by trauma while playing with bat/ball （15.7%） and finger nail trauma （13.2%）. Among open globe injury, trauma with needle, knife, glass and pen were common causes. Home was the most common place of injury （47.8%）, followed by streets （17.9%） and playground （14.9%）. Conclusion： Children are vulnerable to ocular trauma and need more supervision. Sharp objects like needles, knives, household chemicals like acids should be out of reach of children.展开更多
We present a case of a pediatric patient with high grade renal injury following a minor fall,where clinical suspicion of occult injury resulted in diagnosis.Additionally,we review the management of high grade renal la...We present a case of a pediatric patient with high grade renal injury following a minor fall,where clinical suspicion of occult injury resulted in diagnosis.Additionally,we review the management of high grade renal lacerations in children,including the role of ultrasound in managing these injuries.展开更多
Background:The pathophysiology of lethal head trauma in infants and young children involves repetitive rotational forces of sufficient magnitude to produce subdural hemorrhage and brain swelling,which leads to conside...Background:The pathophysiology of lethal head trauma in infants and young children involves repetitive rotational forces of sufficient magnitude to produce subdural hemorrhage and brain swelling,which leads to considerable morbidity and mortality.The precise mechanism for brain swelling is unclear.Materials and Methods:We examined cerebral tissue from ten pediatric deaths due to blunt force trauma,along with seven control infants who asphyxiated in unsafe sleep environments.To assess the competence of the blood-brain barrier,we performed immunohistochemical stains for albumin and immunoglobulin G(IgG).Results:IgG and albumin were increased in subpial and superficial perivascular tissue in those cases due to blunt force trauma,and in particular,the blunt force trauma associated with subdural hematoma.This included two deaths at the scene without hospital survival time.Conclusions:Our findings suggest disruption of the blood-brain barrier with vasogenic edema as an early event in head trauma involving young children upstream of global ischemic brain injury.We hypothesize that mechanical injury to the cortical vasculature results in vasogenic edema by oncotic(increased plasma proteins in the cortical interstitium)and hydrostatic(increased capillary pressure)mechanisms,with subsequent cortical ischemia.This may explain why ischemic sequelae appear to occur in head trauma involving young children,regardless of whether anoxia,hypotension,or cardiac arrest complicate the disease course and may in part underlie the high morbidity and mortality of head trauma in early childhood.展开更多
文摘Objective: The exploration of epidemiological patterns of trauma in underage patients serves as a critical reference for the prevention and treatment of trauma in minors. Methods: Data from all cases at the trauma center of the First Hospital of Lanzhou University were collected for the period from November 1, 2020, to October 31, 2023. Cases involving underage trauma patients with complete and quality-controlled data were selected for retrospective analysis. The data analyzed included age, gender, time of trauma, cause of trauma, and major injured body parts. Results: A total of 4568 underage trauma patients were identified, comprising 3093 males and 1475 females, resulting in a male-to-female ratio of 2.10:1. Trauma incidents were most prevalent between April and October, with fewer occurrences in November and December. Daily trauma incidents peaked between 18:00 and 22:00, while fewer incidents were recorded from 00:00 to 08:00. Among children aged 0 to 6 years, the highest number of injuries was observed. Falls were the predominant cause of trauma, accounting for 52.78%. In terms of the main injured body parts, the limbs/skin were the most affected (60.22%), followed by the head/neck region (32.03%). A statistically significant disparity was observed in the association between distinct causes of trauma and major injured body parts (P Conclusion: Trauma among minors occurs more frequently in males than in females, with the highest incidence observed among preschool-aged children. Falls are the primary cause of these injuries. Strengthening fall prevention measures, particularly for preschool-aged children, along with enhancing their self-protective awareness and traffic safety consciousness, can effectively reduce the incidence of injuries among minors, thereby safeguarding their health and well-being.
文摘Importance:Reported coronavirus disease 2019(COVID-19)pandemic effects on pediatric trauma have been variable.Objective:We investigated the characteristics of pediatric trauma including alcohol use during the pandemic at our urban trauma center.Methods:The trauma database of our adult level 1 trauma center was queried for all pediatric(age≤18 years)patients presenting between March 1,2020,and October 30,2020.Data from 2017 to 2019 served as a control.Variables analyzed included demographics,mechanisms,injury severity,hospitalization characteristics,and positive blood alcohol.Results:Pandemic pediatric trauma volumes increased by 67.5%(330/year vs.197/year).Pandemic patients were younger(median age 13 vs.14 years,P=0.011),but similar in gender,ethnicity,severity,hospital length of stay,mortality,and rates of penetrating injury.Falls doubled(79/year vs.34/year)and shifted away from high falls>6 meters(0%vs.7.9%)to moderate falls 1–6 meters(58.2%vs.51.5%)(P=0.028).Transportation injury rates were similar however mechanisms shifted from motor vehicle crashes(−13.5%)towards recreational vehicles including motorcycles(+2.1%),all-terrain vehicles(+8.6%),and bicycles(+3.8%)(P=0.018).Pediatricpositive blood alcohol was significantly higher(11.2%vs.5.1%,P<0.001),especially for ages 14–18 years(21.7%vs.9.5%,P<0.001).Interpretation:Pediatric trauma volumes during the COVID-19 pandemic increased.Pandemic patients had more recreational vehicle injuries and higher rates of positive blood alcohol.This suggests an increased need for alcohol assessment and targeted interventions in the pediatric population during pandemics or periods of school closures.
文摘Introduction: Facial fractures are uncommon injuries in children. Pediatric maxillofacial fractures constitute 1% to 15% of all facial fractures, but show different clinical features when compared with adult patients. Worldwide, the major causes of fractures in children are accidents, falls, violence, and sports- related accidents. Facial trauma in children may result in injury to the facial growth centers, leading to subsequent developmental abnormalities in the injured area. Patients & Methods: Data of pediatric and adolescent patients (0 - 17 years), with a history of trauma, has been compiled over a period of 6 years. History, clinical and radiographic data records were analyzed. Compilation was done in the following categories;age and sex distribution, etiology, site of trauma and associated soft tissue injuries were recorded. The treatment rendered has also been mentioned. Results: A total of 340 patient records were assessed. Demographic data, etiology, type of fracture, associated injury and treatment rendered were recorded. It was found that males (54.7%) were more frequently affected than females (45.3%). Incidence of trauma was more in children belonging to the pre-school age group (38.5%) and the most common etiology was sports-related injuries (43.8%). Dentoalveolar fractures were the most common type (58.5%) of fractures seen in the patients. Most of the patients were managed by conservative treatment (35%) or closed reduction (48%), while a few required open reduction (7.9%). Conclusion: It is felt that this data will be useful in determining the pattern and etiology of maxillofacial trauma in pediatric patients in an Indian setting. Additionally, an outline of the treatment plan in different types of fractures is also summarized.
文摘AIM:To evaluate the predictive value of pediatric penetrating ocular trauma score(POTS)on the visual outcome in children with open globe injury.METHODS:A retrospective study in 90 children(60 males and 30 females)aged 1-15 y(average,7.48±2.86 y)with penetrating ocular trauma was performed.Each patient’s POTS was calculated.The effects of POTS on final visual acuity(FVA)were examined.Correlation between factors affecting POTS and the FVA was established.RESULTS:All patients presented with single-eye trauma.The follow-up time was 3-21 mo(average,10.23±3.54 mo).Among the 90 cases of penetrating wounds,71 eyes(78.89%)were injured in Zone I(wound involvement limited to the cornea,including the corneoscleral limbus),17 eyes(18.89%)were injured in Zone II(wound involving the sclera and no more posterior than 5 mm from the corneoscleral limbus),and 2 eyes(2.22%)were injured in Zone III(wound involvement posterior to the anterior 5 mm of the sclera).Analysis of POTS and FVA showed important correlation between them(r=0.414,P=0.000).Initial visual acuity(P=0.00),age(P=0.02),injury location(P=0.002),traumatic cataract(P=0.00),vitreous hemorrhage(P=0.027),retinal detachment(P=0.003),and endophthalmitis(P=0.03)were found to be statistically significant factors for the FVA outcome.CONCLUSION:Ocular trauma presents serious consequences and poor prognosis in children.The POTS may be a reliable prognostic tool in children with open globe injury.
文摘AIM: To evaluate the predictive value and applicability of Ocular Trauma Score(OTS) and Pediatric Ocular Trauma Score(POTS) for closed and open globe injuries in the pediatric group.METHODS: A retrospective study of closed and open globe injuries in children age of 0-18-year-old between 2012-2019 was conducted.Medical records were collected,and injuries were classified using Birmingham Eye Trauma Terminology System(BETTS).The predictive value and applicability of both OTS and POTS to final visual acuity(VA) were analyzed.RESULTS: Of 84 patients,59(70.2%) presented with closed globe injuries(CGI) and 25(29.8%) with open globe injuries(OGI).The mean of initial VA was 0.832±0.904 log MAR.OTS and POTS was calculated.Initial VA(P<0.001) and traumatic cataract(P<0.001) were significantly associated with visual outcome,followed by organic/unclean wound (P=0.001),delay of surger y(P=0.001),iris prolapse(P=0.003),and globe rupture(P=0.008).A strong correlation between OTS and POTS and final VA(r=-0.798,P<0.001;r=-0.612,P<0.001) was found.OTS was more applicable in all age group of pediatric and in contrast to POTS,it was designed for 0-15 years old.POTS requires eleven parameters and OTS six parameters.Even though initial VA was not available,we could still calculate into POTS equation.CONCLUSION: OTS and POTS are highly predictive prognostic tools for final VA in CGI and OGI's in children.
文摘BACKGROUND Open long bone fractures are a major concern for pediatric patients due to the risk of surgical site infection(SSI).Early studies have recommended irrigation and debridement of open fractures within 6 hours-8 hours for the prevention of SSI.According to the American College of Surgeons(ACS)Best Practice Guidelines,in 2015,irrigation and debridement should be done within 24 hours.AIM To identify whether early irrigation and debridement,within 8 hours,vs late,between 8 hours and 24 hours,for pediatric open long bone fractures impacts rate of SSI.METHODS Using retrospective data review from the National Trauma Data Bank,Trauma Quality Improvement Project(TQIP)of 2019.TQIP database is own by the ACS and it is the largest database for trauma quality program in the world.Propensity matching analysis was performed for the study.RESULTS There were 390 pediatric patients with open long bone fractures who were incl-uded in the study.After completing propensity score matching,we had 176 patients in each category,irrigation and debridement within 8 hours and irrigation and debridement between 8 hours and 24 hours.We found no significant differences between each group for the rate of deep SSI which was 0.6%for patients who received surgical irrigation and debridement within 8 hours and 1.1%for those who received it after 8 hours[adjusted odd ratio(AOR):0.5,95%CI:0.268-30.909,P>0.99].For the secondary outcomes studied,in terms of length of hospital stay,patients who received irrigation and debridement within 8 hours stayed for an average of 3.5 days,and those who received it after 8 hours stayed for an average of 3 days,with no significant difference found,and there were also no sig-nificant differences found between the discharge dispositions of the patients.CONCLUSION Our findings support the recommendation for managing open long bone fractures from the ACS:Complete surgical irrigation and debridement within 24 hours.
文摘Traumatic cataract resulting from open- or closed-globe ocular trauma is one of the most common causes of blindness. Visual outcome is unpredictable because this is not determined solely by the lens. There is a lack of a standard classification, investigations, and treatment guidelines related to the outcome, with considerable debate regarding predictive models. We review the predictors of visual outcome following surgical treatment of traumatic cataracts, which may act as a guide to clinicians.
文摘Isolated duodenal perforation(IDP)in pediatric trauma is rarely reported.Since most of the children with blunt trauma are managed expectantly,timely diagnosis is imperative to avoid morbidity and mortality.We report a case of IDP and emphasize on certain specific clinical features indicating possibility of duodenal injury.We also stress upon the role of early contrast-enhanced computerized tomography(CECT)in such cases.
文摘Aim:The utilization of free-tissue transfer secondary to traumatic lower extremity defects in the pediatric population is scarcely described.Factors include microsurgeon inexperience,inadequate center resources,and fear of historically described poor surgical outcomes.The aim of this study is to investigate more recent articles describing free-flap microsurgical reconstruction for these defects.Methods:A systematic review of the literature was conducted through the online databases PubMed,Embase,and Web of Science,examining for articles with at least 20 subjects utilizing free-tissue transfer for soft-tissue defects of the pediatric(aged 18 and younger)lower extremity following traumatic etiology since 2005.Outcomes included flap failure,return to the operating room,and functional status,where available.Results:Seven studies were deemed appropriate for inclusion,with a total of 243 flaps included.Motor vehicle and motorcycle accidents were greater than 75%of total etiology.Most defects involved the foot or ankle(65.1%).In total,perforator flaps compromised the majority of flaps(54%),with the most common being the anterolateral thigh,the scapular/parascapular,and deep inferior epigastric flaps.Less common perforators included the groin flap,tensor fascia lata,radial forearm,lateral arm,and thoracodorsal perforator flap.Muscle-based flaps were less common(46%),with the latissimus dorsi and rectus muscle flaps composing the majority.The most commonly used recipient vessel was the anterior tibialis(49.5%)and posterior tibialis vessels(45.3%).Most studies performed reconstruction within 7-10 days of presentation.There was a cumulative 6.5%flap failure rate.Conclusion:Free tissue transfer for pediatric lower extremity trauma is an important tool that likely leads to powerful outcomes.Recent trends indicate increasing usage of perforator flaps.This study shows that based on existing data,free flap utilization for pediatric patients is an adequate modality for repair,and may warrant greater consideration moving forward.
文摘Purpose： Ocular trauma is one of the most common causes of acquired blindness in children. It measures about 8%-14% of total childhood injuries. This study aims to determine the epidemiological profile of ocular trauma in the pediatric age group attending a tertiary hospital in northern India. Methods： A retrospective study was conducted in our hospital between June 2014 to July 2015 and all the children aged 0-16 years presenting with ocular trauma in eye outpatient department and emergency were enrolled in the study. Various epidemiological parameters like age, sex distribution, duration of presentation, mode of injury, type of injury and final visual outcome were analyzed. Results： Of total 357 patients, 271 （76%） were below the age of 12 years： 41.1% of children with ocular trauma belonged to age group 2-6 years. The male to female ratio was 2.9：1. Out of total patients, 242 （67.8%） presented with closed globe injury. Among the closed globe injury, the history of fall was present in about 35% of children, followed by trauma while playing with bat/ball （15.7%） and finger nail trauma （13.2%）. Among open globe injury, trauma with needle, knife, glass and pen were common causes. Home was the most common place of injury （47.8%）, followed by streets （17.9%） and playground （14.9%）. Conclusion： Children are vulnerable to ocular trauma and need more supervision. Sharp objects like needles, knives, household chemicals like acids should be out of reach of children.
文摘We present a case of a pediatric patient with high grade renal injury following a minor fall,where clinical suspicion of occult injury resulted in diagnosis.Additionally,we review the management of high grade renal lacerations in children,including the role of ultrasound in managing these injuries.
文摘Background:The pathophysiology of lethal head trauma in infants and young children involves repetitive rotational forces of sufficient magnitude to produce subdural hemorrhage and brain swelling,which leads to considerable morbidity and mortality.The precise mechanism for brain swelling is unclear.Materials and Methods:We examined cerebral tissue from ten pediatric deaths due to blunt force trauma,along with seven control infants who asphyxiated in unsafe sleep environments.To assess the competence of the blood-brain barrier,we performed immunohistochemical stains for albumin and immunoglobulin G(IgG).Results:IgG and albumin were increased in subpial and superficial perivascular tissue in those cases due to blunt force trauma,and in particular,the blunt force trauma associated with subdural hematoma.This included two deaths at the scene without hospital survival time.Conclusions:Our findings suggest disruption of the blood-brain barrier with vasogenic edema as an early event in head trauma involving young children upstream of global ischemic brain injury.We hypothesize that mechanical injury to the cortical vasculature results in vasogenic edema by oncotic(increased plasma proteins in the cortical interstitium)and hydrostatic(increased capillary pressure)mechanisms,with subsequent cortical ischemia.This may explain why ischemic sequelae appear to occur in head trauma involving young children,regardless of whether anoxia,hypotension,or cardiac arrest complicate the disease course and may in part underlie the high morbidity and mortality of head trauma in early childhood.
