Traumatic diaphragmatic rupture in pediatric age: review of the literature

Abstract

Purpose Despite a rising incidence in proximal humeral fractures, there is still no evidence for the best treatment option, especially for elderly patients. The aim of this retrospective cohort study was to evaluate health-related quality of life (HRQoL), functional outcome, pain and social participation in elderly patients, after operative and nonoperative treatment of displaced 3-and 4-part proximal humeral fractures. Methods 150 patients aged ≥ 65, treated for a displaced 3-or 4-part proximal humeral fracture between 2004 and 2014, were invited to participate. Eventually 91 patients (61%) participated, of which 32 non-operatively treated patients were matched to 32 of the 59 operatively treated patients by propensity score matching. The EQ-5D, DASH, VAS for pain and WHODAS 2.0 Participation in Society domain were administered. Complications and reinterventions were registered. Results No significant difference was found between the two treatment groups in HRQoL (p = 0.43), function (p = 0.78) and pain (p = 0.19). A trend toward better social participation in the operative group (p = 0.09) was found. More complications and reinterventions occurred in the operative group than the nonoperative group, with 9 versus 5 complications (p = 0.37) and 8 versus 2 reinterventions (p = 0.08). Conclusions In this study, we found no evidence of a difference in HRQoL, functional outcome or pain 1-10 years after operative or nonoperative treatment in patients of 65 and older with a displaced 3-or 4-part humeral fracture. Operatively treated patients showed a trend toward better social participation but also higher reintervention rates.

A 15-Year-Old Female Presenting With Traumatic Diaphragmatic Hernia One Year After a Car Accident

“…Marzona et al found that respiratory concerns are the most common presenting issue in both pediatric and adult patients. Additionally, gastrointestinal symptoms, if present, are more commonly found in adults [ 7 ]. This is particularly interesting as our patient was a 15-year-old female who presented with symptoms more likely found in an adult with TDH [ 7 ].…”

Clinical-evolutive, diagnostic and treatmental particularities in traumatic diaphragmatic hernia in children. Clinical case presentation and literature review

“…It is considered that only 25-50% of traumatic lesions of the diaphragm are diagnosed by initial chest radiography [4]. According to reports, this method allows the detection of pathognomonic or suggestive signs in 70-85% of cases, while CT of the chest and abdomen confirms the diagnosis, with a sensitivity of up to 82% and a specificity of 87% [8]. Radiological signs suggestive of HDT include: elevated hemidiaphragm, distorted and obscured diaphragmatic margins, presence of intestinal shadows or air levels above the diaphragm, pleural collection, pulmonary collapse, and contralateral displacement of mediastinum [1].…”

“…The incidence of HDT ranging from 0.08% to 8% is reported in the literature, with mortality rates ranging from 16.6% to 33.3% [3]. The reduced frequency, the non-specificity of the symptoms, the clinical evolution with associated lesions causes multiple diagnostic difficulties in 50-70% of cases, a high index of suspicion being necessary [8]. Late manifestation of traumatic lesions of the diaphragm is studied more in adults than in children [4].…”

Paediatric traumatic rupture of the diaphragm

“…Traumatic diaphragmatic rupture (TDR) in the presence of other injuries and owing to its rarity may be easily missed in children (1,2). When presentation is delayed, morbidity and mortality rates increase proportionately (1,2). TDR may mimic conditions such as pneumothorax and bowel obstruction.…”