Number of positive radiographic findings in pediatric trauma patients

Purpose

Conventional radiography is frequently performed in pediatric patients in whom fractures and dislocations are suspected. However, until now, the rate of positive findings of the most commonly performed radiographic examinations in pediatric patients is unknown. The aim of this study was to evaluate the number of positive findings in the 20 most frequently requested standard radiographic examinations in pediatric patients in a level 1 trauma center systematically.

Methods

A transversal cohort study was conducted at a level 1 trauma center in Germany (2008–2014). In a statistical pre hoc analysis, a sample size of 200 images of each standard radiograph was determined. The picture archiving and communication system (PACS) was searched for radiographic examinations in patients under 18 years.

Results

The following fracture rates for the investigated 20 most common examinations were found: 70.5% clavicle, 54.5% forearm, 53% wrist, 41.5% elbow, 30.5% lower leg, 20% hand, 18.5% finger, 12.5% toe, 12% forefoot, 11.5% ankle, 9% shoulder, 6.5% patella, 5.5% foot, 4% knee, 2% conventional rib series, 1.5% lumbar spine, 1% Towne view, 0.5% skull, 0% cervical spine, and 0% odontoid. Differences in the mean age of analyzed pediatric trauma patients in correlation to different standard radiographs were found.

Conclusions

In our study, a relevant amount of different standard radiographs revealed a low fracture rate. Therefore, indications for X-ray should be checked properly and alternative procedures should be discussed with the patient and the parents. Clinical decision rules should be developed and pathways have to be implemented to minimize radiation exposure, waiting time, and costs.

     

Kalkaneusfraktur im Kindesalter nach Umknicktrauma

We report the case of a 12-year-old boy with a calcaneal fracture due to a simple supination trauma. As magnetic resonance imaging (MRI) showed a non-displaced extra-articular fracture no surgical treatment was necessary. A conservative therapy using calcaneal fracture orthosis with full weight bearing was carried out. Using this procedure allowed a comfortable means of movement without the need for a plaster cast immobilization or forearm crutches accompanied by a rapid return of the child to the normal daily routine.     

Das schmerzhafte Os intermetatarseum

The os intermetatarseum is an uncommon accessory bone of the foot, usually found between the bases of the first and second metatarsal bones. Two cases of a painful os intermetatarseum in athletes are reported. Surgical excision of the os intermetatarseum relieved the pain in both patients. Case reports concerning athletes with a painful os intermetatarseum are rare. An os intermetatarseum should be taken under consideration when evaluating dorsal midfoot pain.     

Neomycin enhances extracellular matrix stability of glutaraldehyde crosslinked bioprosthetic heart valves

Glutaraldehyde (GLUT) crosslinked porcine aortic heart valves are continued to be extensively used in heart valve replacement surgeries. GLUT does not crosslink glycosaminoglycans in the tissue and we have demonstrated that GAG loss is associated with tissue degeneration. In this study, we examined the ability of neomycin to enhance GLUT crosslinking to stabilize GAGs, as well as provide evidence of improved functional integrity. Neomycin enhanced GLUT crosslinked (NG) leaflets exposed to collagenase and elastase enzymes exhibited an increased resistance to proteolytic degradation. Furthermore, NG leaflets exhibited small but significant increases in collagen denaturation temperatures when compared to that of standard GLUT crosslinked BHVs. NG leaflets subjected to storage, accelerated cyclic fatigue, and in vitro enzyme mediated GAG degradation revealed improved GAG stabilization versus standard GLUT crosslinked valves, which sustained substantial decreases in GAG content. Ultrastructural analysis using transmission electron microscopy qualitatively confirmed NG leaflets preserved GAGs after enzymatic degradation. Biomechanical analyses demonstrated that NG leaflets were functionally similar to GLUT tissues but were slightly stiffer under both planar biaxial tension and under flexure. Interestingly, after GAGase treatment, GLUT tissues showed increased areal compliance and reduced hysteresis, while NG leaflets were unchanged. Collectively, NG cross-linking functionally insulated the tissue from GAG digestion, and imparted modest additional matrix stiffness but maintained tissue hysteresis properties.     

Dorsomediale talokalkaneare Koalition

Talocalcaneal coalitions are rare but a posterior facet talocalcaneal coalition is even rarer. There are three different types: fibrous, cartilaginous and osseous coalitions. Besides conventional x-rays computed tomography is essential for assessment of the subtarsal joint. In the absence of concomitant coalitions and foot deformity resection of the coalition is advocated due to good clinical results when there is an adequate size of the talocalcaneal joint (>50%) and without osteoarthrosis. A case of a rare posterior facet talocalcaneal coalition is reported.     

26th Meeting of the Pediatric Section of the German Society of Trauma Surgeons (DGU) June 21–23, 2007 Graz,Austria

Abstracts

26th Meeting of the Pediatric Section of the German Society of Trauma Surgeons (DGU) June 21–23, 2007 Graz, Austria     

Traumatische Apophysenl?sung des Trochanter minor

An avulsion fracture of the lesser trochanter is a very rare injury often misdiagnosed as a muscle lesion or hip distortion. This report concerns the avulsion fracture of the lesser trochanter of a 13-year-old boy, suffered on a runway preparing for a long jump. Conservative treatment without weight-bearing was indicated for 6 weeks. Twelve weeks after the injury the patient resumed his normal sport activities.