Pediatric knee fractures

PURPOSE OF REVIEW: Fractures about the knee are a common occurrence in children, and characteristics of the growing skeleton make children susceptible to specific fractures that do not occur in adults. The purpose of this review is to help the clinician to recognize, understand, and appropriately treat these injuries. RECENT FINDINGS: Pediatric knee fractures are diagnosed by a comprehensive history and physical examination supplemented with appropriate imaging modalities. Depending on the injury, treatment may include immobilization, arthroscopic treatment, or open reduction and internal fixation. SUMMARY: A thorough understanding of pediatric knee fractures will enable clinicians to appropriately manage these injuries and provide patients with a rapid return to preinjury activities.     

MR of physeal fractures of the adolescent knee

The aim of this study was to assess physeal fractures of the pediatric knee identified by MR imaging and to describe the MR findings of such fractures. The authors reviewed 315 consecutive pediatric knee MR examinations done to assess for traumatic injury. The MR images were reviewed for evidence of physeal fracture. Fractures were classified by the Salter-Harris system, and associated findings and injuries were noted. Plain radiographs and medical records were reviewed. Seven distal femoral physeal fractures (Salter II, n = 6; Salter III, n = 1) and two proximal tibia physeal fractures (Salter III, n = 1; complex Salter IV, n = 1) were identified. Magnetic resonance demonstrated widening of a portion of the physis with visualization of a metaphyseal/epiphyseal fracture line. Periosteal elevation was observed in six cases. Four patients had associated ligamentous or meniscal injuries. Plain radiographs were available for review in eight patients. Bone abnormalities suggesting fracture were evident in six of eight patients; however, the fracture was fully delineated in only one patient. The diagnosis or confirmation of fracture by MR changed clinical management in seven of eight patients in whom follow-up was available. Physeal fractures of the pediatric knee are occasionally diagnosed by MR. Magnetic resonance provides improved delineation of non-displaced physeal fractures of the knee, while simultaneously allowing for evaluation of soft tissue structures. Received: 25 October 1999/Accepted: 6 June 2000     

Ultrasonographic findings in pediatric fractures

The aim of this study was to document and analyze ultrasonographic (US) findings in different types of pediatric fractures. Thirty-nine patients, aged between 1 and 14 years, with a fracture were included in the study. Patients were classified as complete or incomplete fractures. Greenstick fractures, torus fractures and plastic deformations were considered as incomplete fractures. Ultrasonographic findings (subperiosteal hematoma, bending, cortical disruption, and reverberating echo) were analysed for each type of fracture. Subperiosteal hematoma was present in all patients in the study. Bending sign was present in all patients in the incomplete fracture group, but not present in complete fractures. Cortical disruption and reverberating echo were present in all patients with complete and greenstick fractures. In conclusion, whether the fracture is complete or incomplete, subperiosteal hematoma, together with a cortical disruption, bending sign, or reverberating echo shown on US can confirm the fracture diagnosis in children.     

The clinical presentation of pediatric pelvic fractures

BACKGROUND: Few studies have addressed the presentation and clinical impact of pediatric pelvic fractures. We sought to describe pediatric blunt trauma patients with pelvic fracture (PF) and to evaluate the sensitivity and specificity of physical examination at presentation for diagnosis. METHODS: Retrospective analysis of all PF and control (NPF) patients from our pediatric institution over an 8-year period. RESULTS: A total of 174 patients (88 PF, 86 NPF) were included. Median patient age was 8 years (range, 3 months to 18 years), with 54% males. The most common mechanisms of injury for PF patients were automobile-related accidents (75%). There were 140 patients (87%) who were transported by air or ground medical services. At presentation, approximately 16% of PF patients had a Glasgow Coma score of <15, a mean Revised Trauma Score of 7.49, and a median Injury Severity Score (ISS) of 9. Thirty-one PF patients (35%) had an ISS of >15 indicating severe, multiple injuries. Sixty-eight PF patients (77%) had severe isolated injuries (Abbreviated Injury Scale 1990 value of >3); 11% of PF patients required transfusions, and 2% died. Fifteen PF patients (17% ) had no pelvic ring disruption; 39 (43%) had a single pelvic ring fracture, 22 (2%) had two pelvic ring fractures, 2 (2%) had acetabular fractures, and 10 (11%) had a combination of pelvic fractures. An abnormal physical examination of the pelvis was noted in 81 patients with PF (92% sensitivity, 95% confidence interval [CI] = 0.89-0.95), 15 NPF patients had an abnormal examination (79% specificity, 95% CI = 0.74-0.84). The positive predictive value of the pelvis examination was 0.84, and the negative predictive value was 0.89. The most common abnormal pelvis examination finding was pelvic tenderness in 65 PF patients (73%). A total of seven PF patients had a normal examination of the pelvis; four had a depressed level of consciousness (defined as GCS <15), and six patients had a distracting injury. CONCLUSIONS: Pediatric blunt trauma patients with pelvic fracture represent a severely injured population but generally have lower transfusion rates and mortality than noted in adult studies. The pelvis examination appears to be sensitive and specific in this retrospective study. However, an altered level of consciousness and/or distracting injuries may affect examination sensitivity and specificity. Based on this retrospective study, we cannot advocate eliminating pelvic radiographs in the severely injured, blunt trauma patient. Prospective studies are recommended.     

Surgical treatment of pediatric femoral shaft fractures

PURPOSE OF REVIEW: Femoral shaft fractures are among the most common fractures in children. Depending on the patient's age, fracture location, pattern, mechanism of injury, and associated injuries, several different treatment options exist. The purpose of this review is to discuss these different clinical situations and the recommended treatment methods, as well as to characterize the latest literature and recommendations. RECENT FINDINGS: In the past several years, there have been significant changes in the approach to the treatment of pediatric femoral shaft fractures, particularly in school-aged children. Young children have traditionally been treated conservatively with good results, and this method is still currently advocated. Adolescents over the age of 12 are generally treated with rigid intramedullary rods. However, in children between the ages of 5 and 12, new surgical treatment modalities have been tested with good outcomes, and, as new data emerge, these methods are becoming preferable to conservative treatment. SUMMARY: Children who sustain femoral shaft fractures can present difficult challenges to both orthopedists and pediatricians. A recent shift in treatment in children between ages of 5 and 12 from nonoperative to surgical intervention has led to shorter hospital stays and earlier return to activity with reliable fracture healing.     

MRI of the knee: key points in the pediatric population

The knee is the joint which is most commonly imaged by MRI in children. With increasing participation in competitive sports at younger ages, knee injuries are common in children. While older adolescents have patterns of injury similar to those seen in adults, injuries seen in skeletally immature patients differ. In this essay, the MR findings of injuries of the skeletally immature knee are highlighted.     

Advances in the surgical management of pediatric femoral shaft fractures

PURPOSE OF REVIEW: To provide an update on surgical methods of pediatric femur fracture treatment. RECENT FINDINGS: Multiple studies describe successful results with elastic nail stabilization of pediatric femur fractures. The indications and risk factors for complications are being more clearly defined. Trochanteric entry-locked intramedullary nailing and submuscular bridge plating have also recently been reported to produce excellent outcomes in a high percentage of patients. Older (>11 years) patients, heavier patients and patients with length-unstable fracture patterns may be best treated with locked nailing or plating. SUMMARY: Pediatric femur fractures can be successfully treated by a number of methods. This review examines the recent literature to provide some guidelines for choosing amongst the options for surgical stabilization.     

106例儿童骨盆骨折的回顾性分析

目的 回顾性分析2003至2007年在我院诊治的106例儿童骨盆骨折的流行病学特点.方法 利用图片存档及通信系统(PACS)及病案查询系统,整理分析我院2003至2007年间诊治的骨盆骨折患儿影像及病历等资料,统计其性别、年龄、损伤部位、儿童骨盆骨折Torode和Zieg分型等项目,并进行分析.结果 本次共调查骨盆骨折患儿106例,男性明显多于女性,男性和女性骨盆骨折高发年龄均为11～15岁,左侧损伤最多,双侧骨折最少.致伤原因以行人机动车交通事故为主,骨折类型以Torode和Zieg分型中Ⅲ型损伤为多见.除骨盆骨折外,伴发其他肢体骨折19例;住院患儿中44.4%(16/36)伴有软组织、严重的脏器或血管等损伤.结论 采取措施减少行人机动车事故是预防儿童骨盆骨折的有效措施,对于伴发脏器、血管等损伤的患儿要早期积极处理;对于移位明显儿童骨盆骨折应行手术治疗.     

弹性髓内钉在儿童肱骨骨折中的应用

目的 分析弹性髓内钉内固定治疗儿童肱骨骨折的临床疗效.方法 2005年3月至2009年2月作者采用钛制弹性髓内钉内固定治疗儿童肱骨骨折26例.结果 患儿均获随访,随访时间为12～32个月,平均20.4个月.均骨折愈合,骨痂生长良好,邻近关节活动和患肢功能恢复正常,术中1例发生两钉缠绕,术后1例出现感染,1例发生皮肤激...