RESUMEN
AIM: Re-manipulation of paediatric forearm fractures under general anaesthetic may be required following inadequate closed reduction under conscious sedation. Manipulation under general anaesthetic carries significant inherent risks and is preferably avoided. We assessed one institution's experience with paediatric forearm fracture reduction and investigate the incidence of re-manipulation under general anaesthetic of fractures initially managed under conscious sedation without fluoroscopy. METHOD: All paediatric forearm fractures presenting to the children's emergency department of our national children's hospital between 1 January 2019 and 30 June 2019 were studied. Radius and ulna fractures were categorised according to fracture location (distal third, middle third, proximal third), any associated injury, and any plan to proceed to the operating room that was documented prior to manipulation in the emergency department. Univariate and multivariate statistical analysis was carried out to test for differences between discrete and continuous data and odds ratios were calculated. RESULTS: Three-hundred and nine patients presented during the study period with 267 being eligible for analysis. Fifteen point seven percent (42/267) required fracture manipulation in the operating theatre following initial reduction in the children's emergency department. Independent risk factors associated with significantly higher rates of failed reduction under conscious sedation (p<0.001-0004) were patients who had a delay in presentation to hospital, were older, or had a non-distal fracture site. CONCLUSION: There are higher rates of re-manipulation under general anaesthetic in children presenting to the emergency department of our national children's hospital with forearm fractures than seen in comparative international studies. Risk factors which predict an inadequate initial reduction and interventions to improve this are discussed.
Asunto(s)
Anestésicos Generales , Traumatismos del Antebrazo , Fracturas del Radio , Anestesia General , Niño , Servicio de Urgencia en Hospital , Antebrazo , Traumatismos del Antebrazo/epidemiología , Traumatismos del Antebrazo/cirugía , Humanos , Incidencia , Nueva Zelanda , Fracturas del Radio/epidemiología , Fracturas del Radio/cirugía , Estudios Retrospectivos , Factores de RiesgoRESUMEN
OBJECTIVES: Does restoration of articular congruity have any effect on long-term outcome following tibial plateau fracture? DESIGN: Cohort study. SETTING: A secondary hospital in New Zealand, which services a population of 150,000. PATIENTS: All patients with a depressed tibial plateau fracture seen over a 6 year period were invited to participate in the study. There were 41 patients (average age 54 years) recruited from an eligible population of 97. Average follow-up was 3.9 years after injury. INTERVENTION: Patients had either been treated operatively or nonoperatively after depressed tibial plateau fracture. MAIN OUTCOME MEASUREMENTS: The primary outcome analyzed was residual articular depression (as measured on coronal plane tomogram) and its effect on clinical outcome [Oxford Knee Score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Knee injury and Osteoarthritis Outcome Score (KOOS), Iowa knee score, and a visual analogue satisfaction score] and functional outcome (knee range of motion) at a minimum of 12 months after fracture. Patients were divided into 3 groups based on the amount of articular depression: <2.5, 2.5-5.0, and ≥5.0 mm. The secondary outcome analyzed was mechanical axis (as measured on weightbearing long leg alignment radiographs) and its effect on clinical and functional outcomes. RESULTS: Statistical analysis found that patients with <2.5 mm of articular depression had significantly smaller losses in knee range of motion (P = 0.000), better Oxford (P = 0.006), Iowa (P = 0.003), and KOOS symptom (P = 0.011) and pain (P = 0.001) scores. We found that there was no significant relationship between restoration of mechanical axis and loss in range of motion (P = 0.126), Oxford (P = 0.584), WOMAC (P = 0.101), IOWA (P = 0.418), Visual Analogue Score (VAS) (P = 0.466) or any subgroup within the KOOS survey other than activities of daily living (P = 0.029). CONCLUSIONS: This study found that patients with smaller amounts of residual articular depression at a minimum of 12 months after tibial plateau fracture had significantly smaller losses in knee range of motion and better functional outcomes than those with greater amounts of articular depression. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.