Pediatric Orthopedic Trauma

Grossman, Jamie; Giliberti, Benjamin; Dolitsky, Robert; Parker, Gregory M.; Kim, Bum; Kutzarov, Kamen; Curatolo, Evan

doi:10.1016/j.pcl.2019.09.010

Cited by 3 publications

(3 citation statements)

References 13 publications

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“…In some cases, the older fractures may have been less severe or minimally displaced, and patients may have delayed medical treatment. Notably, acute with chronic healing fractures is considered pathognomonic for child abuse in pediatric patients 23 . Grossman et al describes “multiple fractures in various stages of healing” as radiographic findings of child abuse.…”

Section: Discussionmentioning

confidence: 99%

Orthopaedic Injury Patterns in Intimate Partner Violence: Defensive Wounds and Fracture Patterns

Willson,

Roddy,

Martinson

et al. 2024

JBJS Reviews

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Background: Intimate partner violence (IPV) is a prevalent issue in the United States, despite universal screening measures for women of reproductive age. Orthopaedic surgeons have a unique opportunity to intervene in cases of IPV as musculoskeletal injuries, including fractures, are the second most common type of injury seen in IPV patients. This systematic literature review aims to identify patterns in musculoskeletal injuries caused by IPV to increase identification of patients afflicted by IPV. Methods: A comprehensive search of PubMed, PsycINFO, and Web of Science yielded 316 articles. Included were cohort studies and literature reviews of patients with an IPV-associated orthopaedic injury. Excluded were case studies, perspective articles, material predating 2003, and studies with pediatric or elderly populations. Sixteen articles met criteria. Results: Data supported historical findings that musculoskeletal injury is the second most common injury in patients with IPV, with upper extremity fractures prevailing. Minimally displaced phalanges fractures were most common (9.9%-64%), and isolated ulnar fractures had significant relative risk of IPV association (8.5-12.8). Patients with multiple fractures of varying chronicity were more likely to be victims of IPV (sensitivity 25.2%, specificity 99.2%, positive predictive value 96.2%), and these chronic fractures matched patterns of acute injury caused by IPV. New findings in male victims included a higher proportion of lower extremity and pelvic fractures seen in male cohorts. Conclusion: This study synthesizes evidence of IPV-related orthopaedic injuries, offering objective criteria for identifying victims. Despite limitations in fracture descriptions, the findings aid various physicians in recognizing IPV victims. Considering ongoing IPV prevalence and screening challenges, further research on injury patterns is recommended. Level of Evidence: Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Orthopaedic Injury Patterns in Intimate Partner Violence: Defensive Wounds and Fracture Patterns

Willson,

Roddy,

Martinson

et al. 2024

JBJS Reviews

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“…As a result, 30%-50% of these children are seen by orthopedic surgeons [ 15 ]. It is important to maintain a high index of suspicion for NAT as the diagnosis is missed in up to 20% of children at the initial presentation [ 15 , 16 ]. Physical examination and radiographic findings in children with NAT include subdural hematomas, conjunctival hemorrhages, posterior rib fractures, fractures in different stages of healing, long bone fractures in young or nonambulatory patients, and metaphyseal corner fractures.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Femoral Shaft Fractures in a Young Child due to Nonaccidental Trauma: A Case Report and Literature Review

Padgett¹,

Kothari²,

Williams³

2023

JOCR

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Introduction: Bilateral femoral diaphyseal fractures in children due to nonaccidental trauma (NAT) are a rare occurrence, with no reported cases currently published in the literature. The authors present a case of an 8-month-old male who presented with bilateral femoral shaft fractures. History, physical examination, and radiographic findings support NAT as the cause of his injuries. Due to the patient’s size and associated comorbidities, he was initially treated with Pavlik harness placement, rather than spica casting. The patient demonstrated appropriate radiographic evidence of fracture healing on follow-up. Case Report: An 8-month-old male with a complex past medical history presents to the emergency department. Per the patient’s mother, he has been demonstrating a progressive loss of movement and refusal to bear weight in his bilateral lower extremities over the preceding 1–2 weeks. Other injuries include facial bruising and lesions indicative of subconjunctival hemorrhages. After orthopedics was consulted, the decision was made to treat the patient’s bilateral femoral shaft fractures with a Pavlik harness, rather than spica casting, due to his small size and associated past medical history. The patient was subsequently discharged under foster care. Follow-up visit demonstrates appropriate fracture healing in the bilateral femoral diaphyses. Conclusion: Many cases of NAT in the pediatric population are initially missed. Orthopedic providers must maintain a high index of suspicion for NAT as many of these patients will present with musculoskeletal injuries. The authors report a rare case of NAT in a male child resulting in bilateral femoral diaphyseal fractures. The patient was successfully treated through Pavlik harness placement. Orthopedic providers should consider Pavlik harness placement as a viable option even for young children >6 months of age presenting with femoral shaft fractures if spica casting or open reduction internal fixation is not appropriate. Keywords: Femoral fracture, nonaccidental trauma, pediatric.

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“…[ 4 ] Additionally, younger children may have larger fracture injuries and more severe fracture displacement, leading to a higher risk of elbow dysfunction and slower recovery of elbow function after injury. [ 5 ] As a result, stable fixation is crucial for this age group, as they exhibit characteristics that are unique, being closer to adults while still having skeletal characteristics of children. [ 6 ] In the case of supracondylar humeral fractures in older children, open reduction and plate internal fixation, which is commonly used for adult humeral fractures, is often not recommended.…”

Section: Introductionmentioning

confidence: 99%

Finite element analysis of modified Slongo’s external fixation in the treatment of supracondylar humeral fractures in older children

Zhao,

Yao,

et al. 2024

Medicine

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Older children over 8 years old are at higher risk of elbow joint stiffness after treatment of supracondylar humeral fractures. The objective of this study was to improve the Slongo’s external fixation system for treating supracondylar humeral fractures in older children. This would be achieved by increasing fixation strength and providing a theoretical basis through finite element analysis and mechanical testing. A 13-year-old female patient with a history of previous fracture was selected for CT data processing to create a three-dimensional model of the distal humerus fracture. Two internal fixation models were established, using the Slongo’s external fixation method with Kirschner wire (Group A) and modifying the Slongo’s external fixation (Kirschner wire tail fixation) (Group B). The fracture models were then subjected to mechanical loading analysis using Finite Element Analysis Abaqus 6.14 software to simulate separation, internal rotation, and torsion loads. A PVC humeral bone model was used to create a supracondylar fracture model, and the A and B internal fixation methods were applied separately. The anterior–posterior and torsional stresses were measured using the Bose Electroforce3510 testing system, followed by a comparative analysis. The finite element simulation results showed that under the same tensile, torsion, and inversion forces, the osteotomy model fixed with Kirschner wire at the distal end in Group B exhibited smaller tensile stress and deformation compared to the unfixed osteotomy model in Group A. This indicated that the fixation strength of Group B was superior to that of Group A. According to the test results of the Bose Electroforce3510 testing system, a simple linear regression analysis was conducted using SPSS software. The K values of rotation angle-torque tests and front and rear displacement-stress tests were calculated for Groups A and B, with Group B showing higher values than Group A. The results of this study supported the significantly enhanced biomechanical reliability and stability of fracture fixation in Group B, which utilized the modified Slongo’s external fixation (Kirschner wire tail fixation). This optimized method provides a new choice for the clinical treatment of supracondylar humeral fractures in older children, backed by both clinical evidence and theoretical basis.

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Pediatric Orthopedic Trauma

Cited by 3 publications

References 13 publications

Orthopaedic Injury Patterns in Intimate Partner Violence: Defensive Wounds and Fracture Patterns

Orthopaedic Injury Patterns in Intimate Partner Violence: Defensive Wounds and Fracture Patterns

Bilateral Femoral Shaft Fractures in a Young Child due to Nonaccidental Trauma: A Case Report and Literature Review

Finite element analysis of modified Slongo’s external fixation in the treatment of supracondylar humeral fractures in older children

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