Background:The lateral humeral condyle fractures in children accounts for one fifth of all elbow fractures. These fractures have a propensity to displace because of the pull of the extensor muscles on the condyle. Objectives:The aim of this study was to examine the epidemiology, injury patterns, complications, and predictors for conservative/surgical management in patients with lateral condyle humeral fractures between 0 and 18 years of age.Methods: This was a single-center retrospective study conducted between January 2006 and December 2016.Results: There were 268 patients identified with lateral condyle elbow fracture. Majority of the patients (81.4%) with lateral condyle humeral fractures presented with either undisplaced or minimally displaced (<2 mm) fractures. The initial management in majority (90.7%) of the patients was conservative. Of the patients, 26.8% had secondary displacement at follow-up. The overall proportion of patients who required surgical intervention was 36.2%. Varus deformity of elbow (2.2%) and malunion (0.4%) were the complications noticed on long-term follow-up. Increased age and undisplaced fracture were statistically significant positive predictors for conservative management. The presence of concurrent elbow injuries and type of fracture (displaced >2 mm) were statistically significant positive predictors for surgical management. Conclusions:Our study demonstrated that majority of the patients with lateral condyle humeral fractures had presented with either undisplaced or minimally displaced (<2 mm) fractures. The positive predictors for conservative management of fractures were increased age and undisplaced fracture. The positive predictors for surgical management of lateral condyle humerus fractures were concurrent injuries in elbow and type of fracture (displaced >2 mm). Physician vigilance to the possibility of additional migration of lateral condyle fractures initially managed conservatively, and the need for subsequent surgical stabilization plays an important role in the management of these fractures.

cellulitis is defined as an infection in front of the orbital septum of the eye and is characterised by development of acute eyelid oedema, tenderness, warmth, chemosis and erythema. [1][2][3] This is a relatively common condition seen in the paediatric population. 4 Periorbital cellulitis has to be promptly distinguished from orbital cellulitis which is an infection occurring posterior to the orbital septum. 5,6,7 Periorbital cellulitis is usually associated with concurrent local pathologies like chalazion, ethmoid sinusitis, dacrocystitis, facial cellulitis, facial or dental surgical procedures, periocular trauma, impetigo and insect bites. 1,8 A thorough history, meticulous clinical examination and identification of risk factors are paramount in the management of this condition. 9 Treatment is predominantly medical with initiation of prompt antibiotic therapy and addressing the underlying pathology. 2 The aim of this study was to describe the epidemiology, clinical profile and outcome of children with periorbital cellulitis attending the paediatric emergency medicine department. We also wanted to determine the correlation of clinical severity index score 10 with development of complications. Materials and MethodsThis was a single-centre retrospective study based on data collected at the Children's Emergency department at KK Women's and Children's Hospital (KKH), Singapore between 2006 and 2016. The study was approved by the SingHealth Centralised Institutional Review Board (CIRB). The data collection was started by identifying all patients with discharge diagnosis of periorbital cellulitis or preseptal cellulitis from the discharge diagnosis and then recording information on: demography, symptoms, aetiology, clinical signs, treatment, follow-up and return visit.Clinical severity index score was calculated for all individual patients by a score validated by Linda Vu et al 10 which included systemic features and local features. All categorical variables were analysed using chi-squared test, while for continuous variables, independent t-test was used. Following this, univariate and multivariate logistic regression analyses were performed, with periorbital cellulitis as the primary outcome.

No abstract

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Among injuries from all recreational activities, bicycle injuries are the leading cause of emergency department (ED) visits. (1) Injuries to cyclists have been established as a significant worldwide public health burden. (2) This is of concern in Singapore, as cycling is a popular form of recreation, exercise and transport. These injuries are mainly due to falls from bicycles and collisions with moving or fixed objects. Fatal and serious injuries are mainly the result of collisions with motor vehicles. (3,4) Among the paediatric population, children aged 10-15 years have the highest fatality rates. (3) While fracture is the major cause of morbidity in children, traumatic brain injury is the leading cause of mortality and long-term disability. (2,4) In addition to this, handlebar accidents resulting in abdominal and pelvic organ injuries also result in a considerable amount of morbidity. (5) Children who ride in bicycle-mounted seats are also at risk for injury, (6) such as when their feet, legs or clothes get caught in the spokes of the wheel. (7) Wearing bicycle helmets is the single most effective measure for prevention of significant bicycle injuries, particularly child bicycle helmets, which have the highest cost-benefit ratio among all injury prevention interventions. (8) As the number of bicycle injuries remains high despite many education programmes aimed at preventing bicycle-related injuries, this retrospective study aimed to describe the patterns of paediatric bicycle-related injuries. METHODS This was a single-centre retrospective study based on data collected at the children's ED at KK Women's and Children's Hospital, Singapore, between 2011 and 2016. This facility was chosen primarily because it is the biggest children's ED in Singapore and manages the majority of children (aged ≤ 16 years) involved in accidents in Singapore. Our data was taken from the trauma registry and included all trauma-related injury, treatment, hospitalisations and deaths at the ED. This study was approved by the SingHealth Centralised Institutional Review Board hospital ethics committee. All data was recorded by trained medical personnel at the ED, including patient demographics, date and time of injury, place of occurrence, injury circumstances, mechanism of injury, interventions done at the ED and, subsequently, the patient's disposition. The mechanism of injury was categorised as follows: (a) fall; (b) direct collision with a bicycle; (c) road traffic accident; or (d) injury caused by a bicycle component. 'Yes' and 'No' variables were used to code interventions performed at the ED, which included radiological imaging, the need for toilet and suturing, manipulation and reduction, cast immobilisations, and the activation of Code Blue and trauma code. Data was entered in Microsoft Excel 2016 (Microsoft Corp, Redmond, WA, USA). SPSS Statistics version 22.0 (IBM Corp, Armonk, NY, USA) was used to generate descriptive data for reporting. Data was shown as number of cases and percentage.