This case report presents entrapment with subsequent complete disruption of the median nerve in the distal ulna in a both-bone fracture of the forearm in a 9-year-old girl. Closed fractures of the radius and ulna commonly occur in pediatric populations. Postinjury nerve dysfunction is often seen. Severe nerve injury is rare. There are only 3 reports of the median nerve becoming entrapped in an ulnar fracture in a child, with no reports of entrapment in the distal forearm. Features seen on examination and the radiographs supported possible nerve entrapment. Although uncommon, nerve entrapment or transection should be considered in all forearm fractures with sensory or motor nerve dysfunction. If suspicions are high, an early diagnosis of nerve entrapment may be obtained with magnetic resonance imaging evaluation.
Background:Socioeconomic status is known to influence outcomes in healthcare. This study compares hip fracture care in patients of different socioeconomic status. Methods:A retrospective study of hip fracture patients over the age 65 with hip fracture who received operative care by a single surgeon was undertaken at an academic level 1 trauma center (county group, n = 47) and two private tertiary care hospitals (private group, n = 78). A standardized hip fracture protocol was initiated for all patients upon admission with the goal of operative management in less than 48 hr. Time-to-surgery, length of stay, and short-term postoperative complications were compared between groups. Results:Patients from the county hospital, which serves a low socioeconomic population, were largely nonwhite (93.6%) with 12.8% uninsured, whereas 32.1% of private patients were nonwhite, and all were insured. County patients had a longer time from presentation to surgery compared with private patients (30.5 hr vs 21.7 hr, respectively, P = 0.003). Length of stay was equivalent between county and private patients (8.0 days vs 7.2 days, respectively, P = 0.060). There was no significant difference in the rate of complications between county versus private groups (21.3% vs. 21.8%, respectively, P = 0.946). Difference in 30-day mortality was not statistically significant (8.5% county vs. 3.9% private, respectively, P = 0.424). No risk factors were associated with significantly increased risk of complications with logistic regression analysis. Conclusions:There was a similar length of stay, complication rate, and mortality rate after hip fracture surgery despite demographic differences between the groups. A fragility fracture protocol can lead to similar outcomes in patients of differing demographics and insurance payor mixes.
Background: Unintentional injuries are the leading cause of morbidity and mortality among children 0 to 18 years of age in the U.S. An estimated 9,400 to 17,000 pediatric lawn-mower injuries occur each year. The aims of this study were to better define the epidemiology of lawn-mower injuries and to identify predictors of severe lawn-mower injuries to optimize public education and injury prevention. Methods: All patients 0 to 18 years of age who presented to Children’s Mercy Hospital (CMH), Kansas City, Missouri, during the period of 1995 to 2015 after sustaining a lawn-mower injury were identified using International Classification of Diseases, 9th Revision (ICD-9) codes. Demographic information and data regarding primary outcome measures (death, amputation, need for prosthesis, Injury Severity Score [ISS]) and secondary outcome measures were collected. Bivariate and multivariate analyses were used to identify risk factors for severe lawn-mower injuries. Results: One hundred and fifty-seven patients were identified, with a bimodal age distribution peaking at 4 and 15 years of age. Seventy-five percent of the subjects were male. Sixty-six percent of the patients were admitted to the hospital, with a mean length of stay of 6 days. An average of 3 operations were performed. Nineteen percent of the patients lived in a nonmetro/rural location. Lower-extremity injuries were most prevalent, affecting 84% of the patients. Forty percent of the patients experienced at least 1 traumatic amputation. Thirteen percent of the patients required a prosthesis after the injury. The average ISS was 8. Significant predictors of a higher ISS included an age of 0 to 9 years, a riding lawn mower, a grandparent operator, and a nonmetro/rural location. Younger children were more likely to be injured from a riding lawn mower, be the passenger of the mower or a bystander, be injured with a grandparent operator, and live in a nonmetro/rural location. Younger children also had a higher ISS and amputation rate, longer LOS, and more surgical procedures. Conclusions: Education to protect younger patients should target parent, grandparent, and older sibling operators. Education for the older, teenage group should include safe mowing techniques. Efforts should also target nonmetro/rural populations and grandparents, specifically highlighting the severe dangers of riding lawn mowers when young children are passengers or bystanders. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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