RESUMEN
The aim of the study was to determine if the use of an Instructional Video will decrease anxiety during cast removal. We enrolled 60 healthy children undergoing their first cast removal following conservative fracture treatment. Patients were divided into one of three groups (1) No Video (control group), (2) watching a video of a well-tolerated pediatric cast removal (Instructional Video), or (3) watching a nonmedical Children's Video during cast removal. We assessed anxiety to the cast saw by recording heart rate in the waiting room, during the procedure, and 1-2 min after the procedure. There were no significant differences in waiting room, procedure, and post-procedure heart rates between the two interventions and the control group. The mean change in heart rate from baseline to the procedure room for the Instructional Video cohort exhibited a similar increase (25.8 beats/min) in heart rate during cast removal as the No Video group (26.3 beats/min), while the Children's Video had the smallest change in heart rate (17.7 beats/min) with a trend towards significance (P = 0.12). The results were not statistically significant for the full linear mixed-effect model on the three measurements. When we use age to control for variability in the data, we have a moderate effect size between Children's Video and control (η2P = 0.0592), revealing that certain ages likely benefited from the Children's Video intervention. Distraction using a Children's Video may help reduce anxiety during cast removal whereas the Instructional Video did not reduce anxiety as hypothesized.
Asunto(s)
Moldes Quirúrgicos , Fracturas Óseas , Ansiedad/prevención & control , Niño , Frecuencia Cardíaca , Humanos , Estudios ProspectivosRESUMEN
This report documents a rare case of isolated trochlear shear fracture in an adolescent patient and provides a literature review. Radiographic analysis of the distal humerus revealed an intra-articular fracture of the anterior trochlea, evidenced by a full moon-shaped osteochondral fragment. Open reduction and internal fixation with two headless Herbert screws secured the fragment. Because of the paucity of information on this injury, standard treatment and management have not been established. Prospective studies with longer follow-up are needed before a consensus with regard to these fractures is established.
Asunto(s)
Lesiones de Codo , Fijación Interna de Fracturas/métodos , Fracturas del Húmero/cirugía , Fracturas Intraarticulares/cirugía , Adolescente , Articulación del Codo/diagnóstico por imagen , Femenino , Humanos , Fracturas del Húmero/diagnóstico por imagen , Húmero/diagnóstico por imagen , Húmero/cirugía , Fracturas Intraarticulares/diagnóstico por imagen , RadiografíaRESUMEN
BACKGROUND: Bier block regional anesthesia was first described in 1908; however, it is uncommonly used for fears of cardiac and neurological complications. Although recent studies have documented safe usage in an adult population, no study to date has investigated its use in a pediatric setting. In addition, most emergency departments feel that splint placement is safer than casting after acute forearm fracture reduction in the pediatric population. However, to our knowledge there is no such study that documents the complication rates associated with immediate casting. The goal of this study was to assess the safety and efficacy of Bier block regional anesthesia and immediate cast application after closed reduction of pediatric forearm fractures. METHODS: A retrospective review was conducted of patients treated for forearm fractures in a 2-year period at a major metropolitan pediatric hospital. Rates of complications and length and costs of the 2 procedures were analyzed. RESULTS: A total of 600 patients were treated with Bier block regional anesthesia and 645 were treated with conscious sedation for displaced fractures of the forearm in the 2-year study period. No complications requiring admission were seen in either group. No patient experienced compartment syndrome or a need for readmission secondary to cast application. 2.2% and 4.3% (P=0.0382) of patients in the Bier block and sedation groups, respectively, needed their cast bivalved secondary to swelling. The average time from initiation of procedural sedation to discharge was 1 hour and 42 minutes, whereas the time to discharge from initiation of Bier block regional anesthesia was 47 minutes (P<0.0001). The average cost for a patient treated with procedural sedation was $6313, whereas the average cost for the Bier block regional anesthesia group was $4956. CONCLUSIONS: Bier block regional anesthesia is a safe, efficient, and cost-effective method of reducing pediatric forearm fractures. Immediate cast application can be used without fear of major complications. LEVELS OF EVIDENCE: Level III--retrospective review.
Asunto(s)
Anestesia de Conducción/métodos , Traumatismos del Brazo/terapia , Moldes Quirúrgicos , Servicio de Urgencia en Hospital , Fijación de Fractura/métodos , Bloqueo Nervioso/métodos , Traumatismos del Brazo/diagnóstico por imagen , Niño , Preescolar , Estudios de Cohortes , Tratamiento de Urgencia , Femenino , Estudios de Seguimiento , Curación de Fractura/fisiología , Hospitales Pediátricos , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Seguridad del Paciente , Radiografía , Fracturas del Radio/diagnóstico por imagen , Fracturas del Radio/terapia , Estudios Retrospectivos , Medición de Riesgo , Resultado del Tratamiento , Fracturas del Cúbito/diagnóstico por imagen , Fracturas del Cúbito/terapiaRESUMEN
Supracondylar humerus fractures occur frequently in children and can be repaired by the lateral or crossed pinning technique, although the importance of pin divergence is unknown. A surgeon's experience using the crossed (N=46) and lateral (N=57) pinning technique was reviewed to determine whether the pin-spread ratio (PSR), the distance between the pins at fracture level divided by the fracture width, was associated with fixation loss. No association existed between the PSR and change in Baumann's angle for fractures repaired by lateral pinning, although one existed for type III fractures repaired with crossed pinning. The PSRs employed in pediatric supracondylar humerus repair appear sufficient for fixation.