OBJECTIVE -This study was designed to explore the timeline of protection against complications in prepubertal children with diabetes, in particular the effects of diabetes duration before age 5 years.RESEARCH DESIGN AND METHODS -In this study, 193 adolescents with prepubertal diabetes onset were followed longitudinally for retinopathy (early background and clinical) and microalbuminuria (albumin excretion rate Ͼ7.5 g/min and Ͼ20 g/min). Multiple logistic regression analysis was used to compare the effect of pre-and postpubertal diabetes duration on the risk of each complication in 90 subjects reassessed as young adults. For the entire cohort, Kaplan-Meier estimates were used to determine time free of each complication, and survival was compared in those diagnosed before and after age 5 years. Accelerated failure time modeling was used to estimate the effect of covariates, including diabetes duration before puberty, on the risk of complications.RESULTS -Prepubertal duration improved the prediction for retinopathy over postpubertal duration alone in the young adults. The survival-free period of retinopathy and microalbuminuria was significantly longer (2-4 years) for those diagnosed before age 5 years compared with those diagnosed after age 5 years. Time to onset of all complications increased progressively with longer diabetes duration before gonadarche. Higher HbA 1c during adolescence had an independent effect on the risk of retinopathy and microalbuminuria.CONCLUSIONS -Prepubertal diabetes duration remains a significant predictor of retinopathy in young adults. The effect of time on the risk of retinopathy and microalbuminuria is nonuniform, with an increasing delay in the onset of complications in those with longer prepubertal duration. These findings are of major clinical importance when setting targets of glycemic control in young children who are at greatest risk of hypoglycemia. Diabetes Care 26:1224 -1229, 2003P arents and health professionals caring for very young children with diabetes must balance the opposing risks of hypoglycemia and future microvascular complications. Although the importance of avoiding severe hypoglycemia in children age Ͻ5 years is well documented (1-3), the relative contribution of these prepubertal years to the development of complications remains less certain (4).In an earlier study using logistic regression, researchers demonstrated that longer prepubertal diabetes duration increased the risk of retinopathy, but not microalbuminuria, in adolescents (5). Studies using survival analysis have also demonstrated that the duration during prepubertal years contributes to retinopathy (6 -8), and one study has demonstrated the contribution of prepubertal duration to microalbuminuria (9). Total duration as a continuous variable was not a significant predictor of microalbuminuria in a Norwegian study, but onset of diabetes before age 13 years conferred an increased risk compared to onset after age 13 years (10). In contrast, a recent study assessing urinary albumin concentration in chil...

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This study identified variables which influence the outcome of surgical management on 126 ununited scaphoid fractures managed by internal fixation and non-vascular bone grafting. The site of fracture was defined by a new method: the ratio of the length of the proximal fragment to the sum of the lengths of both fragments, calculated using specific views in the plain radiographs. Bone healing occurred in 71% (89) of cases. Only the site of nonunion (p = 1 x 10(-6)) and the delay to surgery (p = 0.001) remained significant on multivariate analysis. The effect of surgical delay on the probability of union increased as the fracture site moved proximally. A prediction model was produced by stepwise logistic regression analysis, enabling the surgeon to predict the success of surgery where the site of the nonunion and delay to surgery is known.

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Iliac crest bone grafts are sometimes preferred to other bone grafts for the treatment of non-unions of fractures of the scaphoid as they are claimed to have better osteogenic potential and biomechanical properties. We retrospectively studied a consecutive cohort of 68 symptomatic established scaphoid non-unions treated by bone grafting. An iliac crest graft was used in 44 cases and a distal radius graft in the other 24. The two treatment groups were comparable in terms of location of the fracture, duration of the non-union and the fixation implants used. Overall union was achieved in 45 of the 68 patients (66%) and the union rate was not influenced by the type of bone graft used. Twenty-nine of the 44 treated with iliac crest bone graft (66%) and 16 of the 24 (67%) treated with distal radial graft united. Donor site pain over the iliac crest was present in nine of the 44 patients in this group.