RESUMEN
BACKGROUND: Displaced lateral condyle humeral fractures in children are treated operatively to maximize function and growth of the elbow. Traditionally an open approach is used for reduction of the fracture, but recent series have shown promising results with closed reduction. Percutaneous pins are typically used for fixation, no matter the reduction method. This retrospective review compares our experience with early complications after open and closed reduction of these fractures. METHODS: We retrospectively reviewed charts and radiographs of operatively treated lateral condyle fractures. The Song and Jakob classification systems were utilized to determine fracture severity. High-grade displacement was defined as Song stage 4 and 5, or Jakob type 3. Data was analyzed by fracture type (high-grade or low-grade) and by treatment method to look for differences in complication rates and treatment differences. Complications were defined as delayed union and infection. RESULTS: 172 fractures were analyzed, 141 were treated open, and 31 were treated closed. There were no statistically significant differences in pin duration, total cast time, additional procedures, or short term complications between the open and closed treatment groups, or the high and low-grade fracture groups. High-grade fractures were more likely to be treated with open reduction (p<0.0001). Pin duration prior to removal was not associated with increased incidence of infection or delayed union. CONCLUSIONS: Closed reduction and percutaneous pinning of lateral condyle fractures amenable to this treatment does not seem to require any changes in postoperative treatment or alter the incidence of early complications when compared to open procedures. LEVEL OF EVIDENCE: IV.
Asunto(s)
Fijación Interna de Fracturas/métodos , Fracturas del Húmero/cirugía , Adolescente , Niño , Preescolar , Femenino , Fijación Interna de Fracturas/efectos adversos , Humanos , Fracturas del Húmero/diagnóstico por imagen , Lactante , Masculino , Complicaciones Posoperatorias , Periodo Posoperatorio , Radiografía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE: To determine vitamin D status in children with spina bifida (SB). METHODS: Charts of all patients with SB at the Shriners Hospital for Children in Houston, Texas, seen between July 2011 and June 2013 were retrospectively reviewed. Daily intake of milk, vitamins, amount of screen time, and time spent outdoors were recorded along with height, weight, body mass index, and serum vitamin D levels. RESULTS: A total of 38 patients were identified. The mean level of vitamin D was 58.8 nmol/L (23.5 ng/dL); 30 (81%) had insufficient levels, 50 to 75 nmol/L (20 to 30 ng/mL), or deficient levels, <50 nmol/L (<20 ng/mL). African American and Hispanic descent correlated with decreased levels (P = 0.017). Daily vitamin D supplementation correlated with increased levels (P = 0.046). CONCLUSIONS: Most children with SB have suboptimal vitamin D levels. Despite living in a sunny climate and spending at least 15 minutes per day outdoors, children with SB have suboptimal vitamin D levels. Healthcare providers should consider the routine measurement of vitamin D levels and advise supplementation accordingly in this patient population.
Asunto(s)
Disrafia Espinal/sangre , Vitamina D/análogos & derivados , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Vitamina D/sangre , Deficiencia de Vitamina D/terapiaRESUMEN
BACKGROUND: The purpose of this study was to evaluate the prevalence of vitamin D deficiency and possible risk factors influencing the vitamin D serum levels in patients with osteogenesis imperfecta (OI). METHODS: Charts of all children with OI seen at Shriners Hospitals for Children in Houston, TX, between November 2008 and June 2011 were reviewed for daily milk and soda consumption, multivitamin and vitamin D supplementation, time spent outside, use of sunscreen, amount of screen time, ambulatory status, height, weight, body mass index (BMI), serum 25 hydroxyvitamin D (25OHD), parathyroid hormone levels, and history of bisphosphonate treatment. RESULTS: Of the 80 children with OI, charts of 44 children (26 female) had documentation of the variables of interest. Mean level of 25OHD was 23 ng/mL (±11) (range, 7 to 58) and 35 (79.5%) patients had insufficient or deficient levels. Significant correlations with low vitamin D levels were found for older age (P<0.001), African American descent (P=0.01), BMI (P<0.001), BMI percentile (P=0.30), consumption of soda (P=0.009), and pamidronate therapy (P=0.004). Evaluated together, the studied variables accounted for a large proportion of the variability of 25OHD levels in patients with OI (P=0.004). CONCLUSIONS: To optimize bone health in children with OI, health care providers need to be aware of patients' risk factors for low vitamin D levels and educate families on the modifiable risk factors of milk and soda consumption, obesity, and vitamin D supplementation. Future research is needed to address the relationship between fractures and vitamin D levels in patients with OI and on the cause and effect relationship between bisphosphonate therapy and vitamin D. LEVEL OF EVIDENCE: Level II.