Background and Aims: The coronavirus outbreak significantly changed the need of healthcare services. We hypothesized that the COVID-19 pandemic decreased the frequency of pediatric fracture operations. We also hypothesized that the frequency of emergency pediatric surgical operations decreased as well, as a result of patient-related reasons, such as neglecting or underestimating the symptoms, to avoid hospital admission. Materials and Methods: Nationwide data were individually collected and analyzed in all five tertiary pediatric surgical/trauma centers in Finland. Operations related to fractures, appendicitis, and acute scrotum in children aged above 16 years between March 1 and May 31 from 2017 to 2020 were identified. The monthly frequencies of operations and type of traumas were compared between prepandemic 3 years and 2020. Results: Altogether, 1755 patients were identified in five tertiary hospitals who had an emergency operation during the investigation period. There was a significant decrease (31%, p = 0.03) in trauma operations. It was mostly due to reduction in lower limb trauma operations (32%, p = 0.006). Daycare, school, and organized sports–related injuries decreased significantly during the pandemic. These reductions were observed in March and in April. The frequencies of appendectomies and scrotal explorations remained constant. Conclusion: According to the postulation, a great decrease in the need of trauma operations was observed during the peak of COVID-19 pandemic. In the future, in case similar public restrictions are ordered, the spared resources could be deployed to other clinical areas. However, the need of pediatric surgical emergencies held stable during the COVID-19 restrictions.

Background: unstable antebrachium diaphyseal fractures in children are nowadays increasingly treated operatively by elastic intramedullary nailing.Aim: Aim of the study was to critically assess both radiological and functional outcome of antebrachium fractures treated by titanium elastic nail (ten) in a pediatric cohort.Material and Methods: this retrospective study investigated 75 consecutive children, who were treated for antebrachium shaft fractures at tampere university hospital during the time period from January 2001 to december 2005. All the fractures were classified according to otA. thirty-five children (mean age 12.3 years) were treated by ten-nailing. twenty four of the forearm fractures were instable, five were open, five were re-fractures and one had ulnar nerve deficit. in all but one patient both forearm bones were fractured. twelve (34%) operations were managed by closed reduction, open reduction was needed in 23 (66%) patients. in 29 cases both bones were fixed with ten-nail. in the four patients with re-fracture in both ulna and radius only the radius was ten-nailed. in one case radius was fixed with ten-nail and ulna with K-wire and in another case radius was fixed with ten-nail and ulna with plate. fracture pattern, mode of reduction, surgical approach, short-and long-term complications and outcome were recorded.Results: twenty three (66%) patients achieved healing of the fractures without any limitation in range of motion. twelve patients with postoperative complication were followed up 31-74 (median of 54) months. eleven (31%) patients had minor postoperative complications and one (0,3%) patient had a volkmann's ischemic contracture. five of complicated patients had more than one problem. immediate post-operative problems were noted in these five patients. At follow-up visits four patients complained of ulnar nail discomfort, two had neural symptoms. Additionally, three children suffered from re-fractures.Discussion: despite various minor complications, ten-nailing is considered suitable treatment for unstable forearm shaft fractures. most of the problems were related to poor technical performance in nailing.

A birth injury is a trauma suffered by neonates during labour. There have only been a few population-based studies concerning the incidence of birth injuries. Moreover, the reported incidences vary widely ranging from 0.2 to 37 per 1000 births, depending on the birth injury and study population. 1-4 Birth injuries may vary from minor soft-tissue injuries to potentially life-threatening intracranial haemorrhages. In previous studies, the most common reported birth injuries are injury to the scalp and cephalohaematoma with an incidence of up to 20.4 per 1000 births. This is followed by clavicle fractures with a varying incidence of 2.4-15 per 1000 births. 1,5

Background Studies of pediatric and adolescent fractures in general report a significant increase in the incidence of upper-extremity fractures as well as in their surgical treatment. The aim of this study was to determine the trends of the incidence and treatment of distal humeral fractures in hospitalized 0-to 18-year-old patients in Finland. Method The study included the entire pediatric and adolescent (\19 years) population in Finland during the 24-year period from 1 January 1987 to 31 December 2010. Data on hospitalized patients were obtained from the nationwide National Hospital Discharge Registry where information is collected from all hospital categories (private, public, and other). Surgical treatment was categorized into three groups; (1) reposition with casting; (2) reposition or reduction and osteosynthesis; (3) reposition or reduction and external-fixation and other fixation methods. Patients were classified into three groups according to age: 0-6 years, 7-13 years, and 14-18 years. Annual incidences were calculated using the annual mid-year population census obtained from the Official Statistics of Finland. Results During the 24-year study period, there were a total of 12,590 hospitalizations with a main or secondary diagnosis of distal humeral fracture. In children aged 0-12 years the overall incidence of hospitalization increased 30 % during the 24-year study period, from 4.5 per 10,000 person-years in 1987 to 5.8 per 10,000 person-years in 2010. There were a total of 5,548 operations. During the study period, surgical treatment by repositioning or reduction with osteosynthesis due to a distal humeral fracture increased by fivefold in patients aged\6 years and by twofold in patients aged 7-12 years of age. The incidences of fracture and treatment in children older than 13 years did not change. Conclusion The incidence of distal humeral fractures and the incidence of repositioning with osteosynthesis increased remarkably in prepubertal children during the 24-year study period in Finland.

Study Design. Retrospective review of consecutive series of patients treated at two institutions. Objective. The aim of this study was to compare the health-related quality of life (HRQoL) and surgical outcomes of Shilla growth guidance and magnetically controlled growing rod (MCGR) treatment in patients with syndromic and neuromuscular early-onset scoliosis (EOS). Summary of Background Data. Knowledge of the outcomes of Shilla instrumentation is limited. Methods. We identified 13 children treated with Shilla and 18 children treated with MCGR with syndromic or neuromuscular EOS (major curve ≥45 degree) before the age of 10 years with minimum 2-year follow-up. Outcome parameters included clinical data, radiographic as well as HRQoL outcomes (EOSQ-24 questionnaire). Results. Mean preoperative major curves were 64 degree (range, 45–108 degree) in the Shilla group and 58 degree (range, 45–85 degree) in the MCGR group (P = 0.151). At final follow-up, mean major curves were 31 degree (range, 9.4–54 degree ) and 30 degree (range, 16–53 degree), respectively (P = 0.392). The mean major curve correction was 45% in the Shilla group and 48% in the MCGR group during the follow-up (P = 0.383). Spinal (T1-S1) and T1-T12 growth were significantly better (P = 0.006 and 0.042) in the MCGR than in the Shilla group during the distraction period. At final follow-up, 11 (85%) children in the Shilla group and 17 (94%) in the MCGR group had achieved T1-T12 length of ≥18 cm (P = 0.202). There were significantly more surgical procedures in the MCGR group (mean 2.6 vs. 1.4, P = 0.034) with no difference in the number of complications (P = 0.768). EOSQ24 domains were similar at final follow-up. Conclusion. Shilla growth guidance provided similar correction of spinal deformity, equal number of complications, but with significantly less surgical procedures in patients treated for EOS when compared with MCGR instrumentation. MCGR provided with slightly better spinal growth during the distraction period. There were no significant differences between the quality of life assessments. Level of Evidence: 3

Background and Aims: Despite several potential complications of elastic intramedullary nailing, it is currently the treatment of choice for femoral diaphyseal fractures in schoolaged children. this study aimed to critically evaluate the complications of titanium elastic nailing in pediatric femoral shaft fractures.Material and Methods: this study evaluated patients with a diaphyseal femoral fracture treated with titanium elastic nailing (ten) in tampere university Hospital in finland. the study group included 32 children with a mean age of 9 years during a 5-year period, from 1 January 2003 to 31 December 2007. Data were collected from medical records and x-rays. mean follow-up time was 42 months.Results: of 32 patients, 9 (28%) reported a postoperative complication. complications were associated with nail prominence in five (16%) patients and instability in four (12%) patients. in patients with nail prominence, the titanium elastic nailing-nail ends were unbent and 10-35 mm outside the cortex of the distal femur. the nail prominence caused pain and delayed knee mobilization until the nail was removed after a mean time of 4 months. in patients with fracture instability, the mean titanium elastic nailing-nail/ medullary canal diameter ratio was 46% and periosteal callus formation was 5.4 mm at the first control. in those with stable fractures, the values were 66% and 9.2 mm, respectively.Conclusions: based on this study, two types of pitfalls in a small volume center were found. titanium elastic nail ends were left unbent and too long. We recommend palpating the nail ends to exclude nail prominence and to verify free movement of the knee after nail cutting and bending. fracture instability was caused by inserting titanium elastic

Background and objective: Femoral fractures in children have significant impact for patients, family, and trauma resources as they usually require hospitalization and surgical treatment. The aim of this study was to determine the incidence and trends of femoral fractures among children and adolescents hospitalized between 1998 and 2016 in Finland and Sweden. Methods: All patients younger than 17 years of age in Finland and Sweden with a femoral fracture treated surgically between 1998 and 2016 were included in the study. Data were collected from National Hospital Discharge Registries. Patients were classified by gender and age into four groups. The annual incidences per 100,000 were calculated using annual mid-year population census data obtained from the Official Statistics of Finland and Sweden. Results: In total, 6410 patients younger than 17 years of age diagnosed with femoral fracture were included in this study. The total incidence per 100,000 femoral fractures was 13.3 in Finland and 11.0 in Sweden. The incidence of femoral fractures decreased during the study period in all age groups, except for teenage Finnish girls. Most of the fractures were located in femoral shaft. Fractures of the upper and distal femur were rare. Male predominance was detected in all age groups older than 1 year. Conclusions: The incidence of femoral fractures decreased in all age groups except in teenage Finnish girls. Majority of femoral fractures were located in femoral shaft with male predominance. In children younger than 1 year of age, female predominance was found.

BackgroundStudies among children experiencing fractures report an increasing trend toward operative management. In the present study, we examined whether the same trend has occurred for humeral shaft fractures in accordance with increasing interest toward intramedullary nailing and other operative treatments. The number, incidence and treatment of all hospitalised 0- to 16-year-old patients with humeral shaft fractures in Finland was assessed over a recent 24-year period.MethodThe study included the entire adolescent (0–16 years) population in Finland during the 24-year period from January 1, 1987, to December 31, 2010. Data on hospitalised patients who sustained humeral shaft fractures were obtained from the nationwide National Hospital Discharge Register (NHDR) of Finland.ResultsDuring the study period, there were a total of 1,165 hospitalisations with a main or secondary diagnosis of humeral shaft fracture. The incidence of hospitalisation due to humeral shaft fractures was 4.8 per 100,000 person-years. The incidence increased only slightly among girls from 3.3 per 100,000 person-years in 1987 to 5.3 per 100,000 person-years in 2010. The incidence of reposition and casting was 1.1 per 100,000 person-years and the incidence of reposition with osteosynthesis, including intramedullary nailing, was 1.4 per 100,000 person-years. The specific incidence of intramedullary nailing remained low with no signs of increased incidence, and the incidence was 0.3 per 100,000 person-years. There were no significant changes in the incidence of surgical treatment during the 24-year study period.ConclusionDespite an overall increasing trend toward operative management of fractures in children, conservative management remains the treatment of choice for humeral shaft fractures based on the low and steady incidence of surgical treatment during the 24-year study period. In addition, the incidence of hospitalisation for fractures remained low without a significant increase during the study period.