RESUMEN
OBJECTIVES: This study aims to investigate the influence of parents and children's psychological attributes and previous fracture history on upper extremity fractures in school-aged and adolescent children. PATIENTS AND METHODS: Between January 2022 and January 2023, a total of 194 participants consisting of 97 cases with upper extremity fractures (23 males, 74 females; median age: 10 years; range, 6 to 16 years) and 97 age-matched controls suffering from growing pains (47 males, 50 females; median age: 10 years; range, 6 to 16 years) were included in this case-control study. Both cases and controls were of school-age or over. The parents of the children were interviewed face-to-face using psychological scales including the Adult Attention Deficit Hyperactivity Disorder Self-Report Scale (ASRS), the Autism-Spectrum Quotient (AQ), the Short Form of the Conners' Parent Rating Scale-Revised (CPRS-R:S), and the Developmental Coordination Disorder Questionnaire 2007 (DCDQ'07). The results derived from these scales and the demographics of the participants were evaluated in terms of their association with the risk of upper extremity fractures. RESULTS: A household income below the official minimum monthly wage (MMW) and a previous fracture history showed a higher risk for upper extremity fractures (odds ratio [OR]=2.38, 95% confidence interval [CI]: 1.07-5.26 and OR=24.93, 95% CI: 3.27-189.98, respectively). In the univariate analyses, elevated scores on the hyperactivity subscale of CPRS-R:S (CPRS-R:SHS) were associated with a higher fracture risk (OR=1.14, 95% CI: 1.05-1.24). Furthermore, both a household income below MMW, a previous fracture history, and higher CPRS-R:S-HS scores were found as independent risk factors for upper extremity fractures in the multivariate regression analysis (OR=2.78, 95% CI: 1.13-6.86, OR=21.79, 95% CI: 2.73-174.03), and OR=1.11, 95% CI: 1.02-1.22, respectively). CONCLUSION: Our study results highlight the importance of known risk factors for upper extremity fractures such as lower monthly wage and the presence of previous fractures. The psychological states of parents and children should be evaluated together.
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Fracturas Óseas , Padres , Humanos , Masculino , Femenino , Niño , Adolescente , Estudios de Casos y Controles , Fracturas Óseas/psicología , Fracturas Óseas/epidemiología , Padres/psicología , Factores de Riesgo , Extremidad Superior/lesiones , Huesos de la Extremidad Superior/lesiones , Encuestas y CuestionariosRESUMEN
ABSTRACT: Childhood obesity is a growing epidemic in the United States, and is associated with an increased risk of lower-extremity physeal fractures, and fractures requiring operative intervention. However, no study has assessed the risk upper extremity physeal fractures among overweight children. Our purpose was to compare the following upper-extremity fracture characteristics in overweight and obese children with those of normal-weight/underweight children (herein, "normal weight"): mechanism of injury, anatomical location, fracture pattern, physeal involvement, and treatment types. We hypothesized that overweight and obese children would be higher risk for physeal and complete fractures with low-energy mechanisms and would therefore more frequently require operative intervention compared with normal-weight children.We performed a cross-sectional review of our database of 608 patients aged 2 to 16âyears, and included patients who sustained isolated upper-extremity fractures at our level-1 pediatric tertiary care center from January 2014 to August 2017. Excluded were patients who sustained pathologic fractures and those without basic demographic or radiologic information. Using body mass index percentile for age and sex, we categorized patients as obese (≥95th percentile), overweight (85th to <95th percentile), normal weight (5th to <85th percentile), or underweight (<5th percentile). The obese and overweight groups were analyzed both separately and as a combined overweight/obese group. Demographic data included age, sex, height, and weight. Fractures were classified based on fracture location, fracture pattern (transverse, comminuted, buckle, greenstick, avulsion, or oblique), physeal involvement, and treatment type. Of the 608 patients, 58% were normal weight, 23% were overweight, and 19% were obese. There were no differences in the mean ages or sex distributions among the 3 groups.Among patients with low-energy mechanisms of injury, overweight/obese patients had significantly greater proportions of complete fractures compared with normal-weight children (complete: 65% vs 55%, Pâ=â.001; transverse: 43% vs 27%, Pâ=â.006). In addition, the overweight/obese group sustained significantly more upper-extremity physeal fractures (37%) than did the normal-weight group (23%) (Pâ=â.007).Compared with those in normal-weight children, upper-extremity fracture patterns differ in overweight and obese children, who have higher risk of physeal injuries and complete fractures caused by low-energy mechanisms.Level of Evidence: Level III, retrospective comparative study.
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Huesos de la Extremidad Superior/lesiones , Fracturas Óseas/epidemiología , Obesidad Infantil/epidemiología , Distribución por Edad , Niño , Preescolar , Estudios Transversales , Femenino , Hospitales Pediátricos/estadística & datos numéricos , Humanos , Masculino , Estudios Retrospectivos , Factores de Riesgo , Distribución por Sexo , Centros de Atención Terciaria/estadística & datos numéricos , Estados Unidos/epidemiologíaRESUMEN
Objective: The objective was to develop a disability-based metric for motor vehicle crash (MVC) upper and lower extremity injuries and compare functional outcomes between children and adults.Methods: Disability risk (DR) was quantified using Functional Independence Measure (FIM) scores within the National Trauma Data Bank-Research Data System for the top 95% most frequently occurring Abbreviated Injury Scale (AIS) 3 extremity injuries (22 unique injuries). Pediatric (7-18 years), young adult (19-45 years), middle-aged (46-65 years), and older adult (66+ years) MVC occupants with an FIM score and at least one of the 22 extremity injuries were included. DR was calculated for each injury as the proportion of occupants who were disabled of those sustaining the injury. A maximum AIS-adjusted disability risk (DRMAIS) was also calculated for each injury, excluding occupants with AIS 4+ co-injuries.Results: Locomotion impairment was the most frequent disability type across all ages. DR and DRMAIS of the extremity injuries ranged from 0.06 to 1.00 (6%-100% disability risk). Disability risk increased with age, with DRMAIS increasing from 25.9% ± 8.6% (mean ± SD) in pediatric subjects to 30.4% ± 6.3% in young adults, 39.5% ± 6.6% in middle-aged adults, and 60.5 ± 13.3% in older adults. DRMAIS for upper extremity fractures differed significantly between age groups, with higher disability in older adults, followed by middle-aged adults. DRMAIS for pelvis, hip, shaft, knee, and other lower extremity fractures differed significantly between age groups, with older adult DRMAIS being significantly higher for each fracture type. DRMAIS for hip and lower extremity shaft fractures was also significantly higher in middle-aged occupants compared to pediatric and young adult occupants. The maximum AIS-adjusted mortality risk (MRMAIS, proportion of fatalities among occupants sustaining an MAIS 3 injury) was not correlated with DRMAIS for extremity injuries in pediatric, young adult, middle-aged, and older adult occupants (all R2 < 0.01). Disability associated with each extremity injury was higher than mortality risk.Conclusions: Older adults had significantly greater disability for MVC extremity injuries. Lower disability rates in children may stem from their increased physiological capacity for bone healing and relative lack of bone disease. The disability metrics developed can supplement AIS and other severity-based metrics by accounting for the age-specific functional implications of MVC extremity injuries.
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Accidentes de Tránsito , Huesos de la Extremidad Inferior/lesiones , Huesos de la Extremidad Superior/lesiones , Fracturas Óseas/rehabilitación , Escala Resumida de Traumatismos , Accidentes de Tránsito/mortalidad , Adolescente , Factores de Edad , Anciano , Niño , Evaluación de la Discapacidad , Personas con Discapacidad , Femenino , Fracturas Óseas/mortalidad , Humanos , Traumatismos de la Rodilla/mortalidad , Traumatismos de la Rodilla/rehabilitación , Masculino , Persona de Mediana Edad , Huesos Pélvicos/lesiones , Estados Unidos/epidemiología , Adulto JovenRESUMEN
OBJECTIVES: The aims of this study were to evaluate the agreement between cone-beam computed tomography (CBCT) and multislice computed tomography for the characterization of extremity fractures and to compare image quality, radiation dose, and patient tolerance. METHODS: Thirty-six patients with suspected fracture affecting distal extremities or who required preoperative fracture assessment were enrolled prospectively. Each patient underwent CBCT and multislice computed tomography the same day. Both examinations were evaluated independently twice by 2 trained radiologists using the Müller AO classification for fracture characterization. RESULTS: Cohen κ coefficient for agreement between the imaging techniques was almost perfect for fracture characterization, κ = 0.94 [95% confidence interval, 0.91-0.98]. There was substantial to almost perfect agreement for secondary findings. Cone-beam computed tomography was well tolerated and significantly less irradiant and had better subjective image. CONCLUSIONS: An excellent agreement between both imaging techniques was found. This confirms the ability of CBCT to assess fractures and its potential in the management of patients with distal limb trauma.
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Tomografía Computarizada de Haz Cónico/métodos , Fracturas Óseas/diagnóstico por imagen , Tomografía Computarizada Multidetector/métodos , Cooperación del Paciente/psicología , Huesos de la Extremidad Inferior/diagnóstico por imagen , Huesos de la Extremidad Inferior/lesiones , Huesos de la Extremidad Superior/diagnóstico por imagen , Huesos de la Extremidad Superior/lesiones , Tomografía Computarizada de Haz Cónico/psicología , Femenino , Humanos , Masculino , Tomografía Computarizada Multidetector/psicología , Estudios Prospectivos , Dosis de Radiación , Intensificación de Imagen Radiográfica/métodos , Radiólogos , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: The aim of the present review is to assess the effectiveness of ultrasound (US) in the detection of upper and lower limb bone fractures in adults compared to a diagnostic gold standard available in secondary and tertiary care centres (e.g. radiography, CT scan or MRI). METHODS: The review followed PRISMA guidelines and used a database-specific search strategy with Medline, EMBASE and The Cochrane Library plus secondary sources (see supplementary material for completed PRISMA checklist). Diagnostic performance of ultrasound was assessed with a qualitative synthesis and a meta-analysis of two data subgroups. RESULTS: Twenty-six studies were included (n = 2360; fracture prevalence =5.3 % to 75.0%); data were organised into anatomical subgroups, two of which were subjected to meta-analysis. Sensitivity and specificity ranged from 42.11 - 100% and 65.0 - 100%, with the highest diagnostic accuracy in fractures of the foot and ankle. The pooled sensitivity and specificity of US was 0.93 and 0.92 for upper limb fractures (I2 = 54.7 % ; 66.3%), and 0.83 and 0.93 for lower limb fractures (I2 = 90.1 % ; 83.5%). CONCLUSION: Ultrasonography demonstrates good diagnostic accuracy in the detection of upper and lower limb bone fractures in adults, especially in fractures of the foot and ankle. This is supported by pooled analysis of upper and lower limb fracture subgroups. Further research in larger populations is necessary to validate and strengthen the quality of the available evidence prior to recommending US as a first-line imaging modality for prehospital use. TRIAL REGISTRATION: The protocol is registered with the PROSPERO International register of systematic reviews: ID = CRD42017053640 .
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Huesos de la Extremidad Inferior/diagnóstico por imagen , Huesos de la Extremidad Inferior/lesiones , Huesos de la Extremidad Superior/diagnóstico por imagen , Huesos de la Extremidad Superior/lesiones , Fracturas Óseas/diagnóstico por imagen , Ultrasonografía , Adulto , HumanosRESUMEN
BACKGROUND: The aim of this study was to assess the incidence of fractures in infancy, overall and by type of fracture, its association with accidents, metabolic bone disease risk factors, and abuse diagnosis. METHODS: The design was a population-based register study in Sweden. Participants: Children born 1997-2014, 0-1 years of age diagnosed with fracture-diagnosis according to International Classification of Diseases (ICD10) were retrieved from the National Patient Register and linked to the Swedish Medical Birth Register and the Death Cause Register. Main outcome measures were fractures of the skull, long bone, clavicle and ribs, categorized by age (younger or older than 6 months), and accident or not. FINDINGS: The incidence of fractures during infancy was 251 per 100 000 infants (n = 4663). Major fracture localisations were long bone (44·9%), skull (31·7%), and clavicle (18·6%), while rib fractures were few (1·4%). Fall accidents were reported among 71·4%. One-third occurred during the first 6 months. Metabolic bone disease risk factors, such as maternal obesity, preterm birth, vitamin D deficiency, rickets, and calcium metabolic disturbances, had increased odds of fractures of long bones and ribs in early infancy (0-6 months): birth 32-36 weeks and long bone fracture [AOR 2·13 (95%CI 1·67-2·93)] and rib fracture [AOR 4·24 (95%CI 1·40-12·8)]. Diagnosis of vitamin D deficiency/rickets/disorders of calcium metabolism had increased odds of long bone fracture [AOR 49·5 (95%CI 18·3-134)] and rib fracture [AOR 617 (95%CI 162-2506)]. Fractures without a reported accident had higher odds of metabolic risk factors than those with reported accidents. Abuse diagnosis was registered in 105 infants, with overrepresentation of preterm births, multiple births and small-for-gestational age. INTERPRETATION: Metabolic bone disease risk factors are strongly associated with fractures of long bone and ribs in early infancy. Fracture cases with abuse diagnosis had a metabolic bone risk factor profile.
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Enfermedades Óseas Metabólicas/epidemiología , Maltrato a los Niños/estadística & datos numéricos , Fracturas Óseas/epidemiología , Complicaciones del Embarazo/epidemiología , Sistema de Registros/estadística & datos numéricos , Distribución por Edad , Factores de Edad , Enfermedades Óseas Metabólicas/etiología , Enfermedades Óseas Metabólicas/metabolismo , Huesos de la Extremidad Inferior/lesiones , Huesos de la Extremidad Superior/lesiones , Causas de Muerte , Comorbilidad , Femenino , Fracturas Óseas/etiología , Fracturas Óseas/metabolismo , Humanos , Incidencia , Lactante , Recién Nacido , Recien Nacido Prematuro , Masculino , Exposición Materna/estadística & datos numéricos , Embarazo , Complicaciones del Embarazo/metabolismo , Costillas/lesiones , Factores de Riesgo , Factores Sexuales , Cráneo/lesiones , Suecia/epidemiologíaRESUMEN
BACKGROUND: Fractures in pediatrics show epidemiological characteristics which are different from fractures in adults. The objective of this study was to examine the injury profiles of open upper extremity fractures (UEFs) in all modes of injury related to road traffic accidents (RTAs) in adult and pediatric hospitalized patients. METHODS: Data on 103,465 RTA patients between 1997 and 2013 whose records were entered in a centralized country trauma database were reviewed. Data on open UEFs related to mode of injury (car, motorcycle, bicycle, and pedestrian) was compared between adult (18+ years) and pediatric (0-17 years) RTA patients. RESULTS: Of 103,465 RTA cases, 17,263 (16.7%) had UEFs. Of 73,087 adults, 13,237 (18.1%) included UEFs and of 30,378 pediatric cases, 4026 (13.2%) included UEFs (p < 0.0001). Of 17,263 cases with UEFs, we reviewed 22,132 fractures with 2, 743 (12.4%) open fractures. Adults had a greater risk for open fractures (2221, 13%) than the pediatric cases (522, 10.3%) (p < 0.0001). Overall, of a total of 22,132 UEFs, most of the fractures were in the radius (22.8%), humerus (20.3%), clavicle (17.5%), and ulna (15.4%). The adult pedestrian group had a significantly higher risk for open UEFs than the pediatric group (11 vs 8%, p = 0.0012). CONCLUSIONS: This study demonstrates the difference between adult and pediatric open fractures in hospitalized RTAs. We showed that adults had a greater risk for open UEFs compared to children, and the adult pedestrian group particularly had a significantly higher risk for open UEFs than the pediatric group.
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Accidentes de Tránsito/estadística & datos numéricos , Traumatismos del Brazo/epidemiología , Huesos de la Extremidad Superior/lesiones , Fracturas Abiertas/epidemiología , Sistema de Registros , Adolescente , Adulto , Factores de Edad , Niño , Preescolar , Humanos , Lactante , Israel/epidemiología , Estudios Retrospectivos , Adulto JovenRESUMEN
Although non-unions in the upper limb are rare different treatment options of this challenging situation are still affected with up to 20% of failure rate due to current literature. Risk factors for delayed and non-union of fractures are mainly the size of the fracture gap and bone loss of open fractures or in primary surgery followed by other relevant internal and external factors. In the upper limb non-unions of long bones are described with up to 30% after operative intervention. Especially in the upper limb range of motion is limited in non-union cases and disables adjacent joints like the shoulder, elbow and wrist hence reducing the total activity level of affected patients. Beside careful investigation of the causes leading to the non-union a comprehensive treatment plan should be defined to achieve successful results. Treatment can be non-operative in several, selected cases, but in the majority of cases revision surgery is necessary to achieve osseous healing. Our own experience showed that non-union in the upper limb are rare and account for only 1.7% of all surgical managed upper limb fractures. Non-union of upper limb fractures occur most frequently in clavicle fractures followed by humeral fractures. Atrophic non-union is the most frequent reason for osseous non-union (57%) and osseous healing after revision surgery in non-unions is completed after a mean of 6.45 months. This article will give a brief overview of the genesis, clinical evaluation, treatment options and recommendations in upper limb non-unions according to the current literature. Key words: fracture, upper-limb, non-union, osteosynthesis, cancellous bone-graft.
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Huesos de la Extremidad Superior/lesiones , Fracturas Óseas/cirugía , Fracturas no Consolidadas/cirugía , Clavícula/lesiones , Manejo de la Enfermedad , Humanos , Húmero/lesiones , Reoperación , Resultado del TratamientoRESUMEN
UNLABELLED: In this cross-sectional study the psychometric properties are examined of the adapted Dutch translation of the Short Musculoskeletal Function Assessment (SMFA) questionnaire in severely injured patients (ISS>15). PATIENTS AND METHODS: Patients (N=173) completed the SMFA, the World Health Organization Quality of Life assessment instrument-BREF (WHOQOL-BREF), the Dutch Impact of Event Scale (IES), the Hospital Anxiety and Depression Scale (HADS) and the Cognitive Failure Questionnaire (CFQ). The Abbreviated Injury Score and the Injury Severity Score were established to determine the injured body area and the severity of the injuries. Exploratory factor analysis (method: PAF) was performed. Correlations were calculated between our SMFA factors and scores on the WHOQOL-BREF, IES, HADS and CFQ. The SMFA scores of the factors Upper extremity dysfunction and Lower extremity dysfunction were compared between subgroups of patients with and without injuries in respectively the upper extremities and the lower extremities. For responsiveness analysis, data were compared with the baseline SMFA measurement of a reference group. RESULTS: A three-factor structure was found: Lower extremity dysfunction, Upper extremity dysfunction, and Emotion. Strong correlations between the SMFA and the other questionnaires were found. Patients with injury of the lower extremities had significantly higher scores on the factor Lower extremity dysfunction than patients without injury of the lower extremities (p=0.017). In none of the factors, a significant difference in mean scores was found between patients with and without injury of the upper extremities. Severely injured patients had significantly higher SMFA scores than the reference group (p<0.001). CONCLUSION: The adapted Dutch translation of the SMFA showed good psychometric properties in severely injured patients. It appeared to be useful to get a general overview of patients' Health Status as well as patients' Health Related Quality Of Life.
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Huesos de la Extremidad Inferior/lesiones , Huesos de la Extremidad Superior/lesiones , Fracturas Óseas/psicología , Traumatismo Múltiple/psicología , Enfermedades Musculoesqueléticas/psicología , Estudios Transversales , Evaluación de la Discapacidad , Femenino , Fracturas Óseas/diagnóstico , Fracturas Óseas/epidemiología , Indicadores de Salud , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Traumatismo Múltiple/epidemiología , Traumatismo Múltiple/terapia , Enfermedades Musculoesqueléticas/diagnóstico , Enfermedades Musculoesqueléticas/epidemiología , Países Bajos/epidemiología , Psicometría , Calidad de Vida , Encuestas y CuestionariosRESUMEN
BACKGROUND: Background: Gender disparities in pediatric fracture events has been well-documented however, less is known about racial disparities. The aim of this study is to investigate the epidemiology of pediatric bone fractures in a Hispanic population. METHODS: This is a retrospective cross-sectional analysis of patient's records from a Pediatric Orthopeadic outpatient clinic in the Southwest region of Puerto Rico during a 1-year span (August 2014 August 2015). Differences in sex, BMI, health insurance coverage, parental educational level and employment status, mechanism of fracture, fracture site, and seasonality were investigated among three age classes (pre-school children, school children and adolescents). RESULTS: The sample consited of 243 subjects (0-21 y/o) sustaining a fracture of any extremity within the study period. Boys were at a higher risk of having a fracture event and as age increased, the male/female ratio also increased. The mean BMI was 18.0 kg/m2, with the highest in the school children age group (20.3 kg/m2). Slighlty more than half of the subjects (55.7%) benefitted from public health insurance coverage. The typical father was a laborer with a high school diploma, while the mother had a high school diploma but was unemployed There was a tendency for the children to suffer a bone fracture while at school (49.4%), followed by fractures at home (34.6%). In both the pre-school and school children groups, the upper extremity was more frequently involved (66.7% and 63.9%, respectively) in fracture events. Finally, there was very little variation in the seasonality of fracture events. CONCLUSION: This study provided valuable epidemiological information about pediatric bone fractures within a Hispanic population. It may contribute to the development and implementation of educational and preventive strategies appropriate to age and sex-differences.
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Huesos de la Extremidad Inferior/lesiones , Huesos de la Extremidad Superior/lesiones , Fracturas Óseas/epidemiología , Adolescente , Factores de Edad , Instituciones de Atención Ambulatoria , Índice de Masa Corporal , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Lactante , Seguro de Salud/estadística & datos numéricos , Masculino , Puerto Rico/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Adulto JovenRESUMEN
The analysis of treatment results of 128 patients aged from 21 to 62 years old with chronic posttraumatic osteomyelitis of the long bones was made at the period from 2006 to 2013. The main group included 67 patients and the method of programmed irrigation aspiration sanation was applied for them. The comparison group consisted of 61 patients and drainage was performed for these patients using the conventional ways. The authors noted good immediate results in the main group in 56 (83,58%) out of 67 patients and in the comparison group - in 43 (70,49%) out of 61 patients. The long-term results were analyzed in 116 (90,6%) out of 128 patients in terms from two to five years after treatment. The rate of recurrences such as formation of purulent fistula were twice less in patients of the main group, than in the comparison group. According to the results of questionnaire SF-36, there was noticed, that patients of the main group got better mean indices of quality of life on all 8 scales compared with the other group.
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Antiinfecciosos Locales/administración & dosificación , Drenaje , Fracturas Óseas/complicaciones , Procedimientos Ortopédicos , Calidad de Vida , Irrigación Terapéutica , Huesos de la Extremidad Inferior/lesiones , Huesos de la Extremidad Superior/lesiones , Diseño Asistido por Computadora , Drenaje/efectos adversos , Drenaje/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Ortopédicos/efectos adversos , Procedimientos Ortopédicos/métodos , Osteomielitis/diagnóstico , Osteomielitis/etiología , Osteomielitis/psicología , Osteomielitis/terapia , Irrigación Terapéutica/efectos adversos , Irrigación Terapéutica/instrumentación , Irrigación Terapéutica/métodos , Resultado del TratamientoRESUMEN
PURPOSE: Animal bite injuries are often encountered in daily practice. In particular, these injuries of the upper limbs can result in severe functional impairment. We have performed early debridement of contaminated tissue and primary closure for these injuries. METHODS: The subjects consisted of 15 patients (6 males and 9 females) aged 1-91 years (mean 53.6 years) who visited our hospital due to animal bite injuries (dog in 9 patients, cat in 6). The bite site was the forearm in 5 patients and the hand in 10. In the operating room, contaminated tissue was removed, and primary wound closure was performed after irrigation. RESULTS: The bite penetrated to the muscle layer in 6 patients, tendon sheath in 5, joint in 1, bone in 1, and involved only the subcutaneous tissue in 3 patients. The mean period until the completion of wound treatment was 19.8 ± 8.4 days. As complications, numbness of finger, metaphalangeal joint contracture and superficial radial nerve injury were observed in each one case. In a patient with bite injury of the palmar and dorsal sides of the thumb reaching the bone, additional debridement was necessary. At the final observation, the visual analog scale was 1.2 ± 1.4, and the Quick Disabilities of the Arm, Shoulder, and Hand score was 9.7 ± 12.2. CONCLUSIONS: Debridement to achieve wound closure is indispensable in patients with animal bite injuries of the upper limbs. The results of our study suggest that thorough debridement allows primary closure, even for animal bite injuries.
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Mordeduras y Picaduras , Huesos de la Extremidad Superior/lesiones , Contractura , Desbridamiento , Traumatismos de los Tejidos Blandos , Extremidad Superior/lesiones , Técnicas de Cierre de Heridas/efectos adversos , Infección de Heridas , Animales , Antibacterianos/uso terapéutico , Mordeduras y Picaduras/complicaciones , Mordeduras y Picaduras/diagnóstico , Mordeduras y Picaduras/terapia , Gatos , Contractura/diagnóstico , Contractura/etiología , Contractura/prevención & control , Desbridamiento/efectos adversos , Desbridamiento/métodos , Perros , Femenino , Humanos , Japón , Masculino , Persona de Mediana Edad , Traumatismos de los Tejidos Blandos/complicaciones , Traumatismos de los Tejidos Blandos/etiología , Traumatismos de los Tejidos Blandos/cirugía , Irrigación Terapéutica/métodos , Resultado del Tratamiento , Infección de Heridas/diagnóstico , Infección de Heridas/etiología , Infección de Heridas/prevención & controlRESUMEN
Radiographs remain the mainstay for initial imaging of suspected fracture in the emergency setting. Missed fractures potentially have significant negative consequences for patients, referring physicians, and radiologists. Most missed fractures are owing to perceptual errors. In this review, we emphasize knowledge of 3 categories of pitfalls as they pertain to the upper extremity: the common but challenging; the out of mind, out of sight; and those related to satisfaction of search. For specific injuries, emphasis is placed on helpful radiographic signs and important additional radiographic views to obtain.
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Traumatismos del Brazo/diagnóstico por imagen , Huesos de la Extremidad Superior/lesiones , Errores Diagnósticos/prevención & control , Fracturas Óseas/diagnóstico por imagen , Luxaciones Articulares/diagnóstico por imagen , Intensificación de Imagen Radiográfica/métodos , Reacciones Falso Negativas , HumanosRESUMEN
The present study is an observational cross-sectional study. The main purpose of this research was to analyze the perception and behaviors of parents in a series of pediatric upper extremity fracture cases. Hundred and seventeen patients younger than 12 years who were conservatively treated for the upper extremity fracture were included in our study. Parents of the patients were requested to answer a family-centered questionnaire related to their child's fracture and its treatment. When the parents were asked whether they believe casting would be sufficient or not as the treatment of their child's fracture, 84.6% answered 'yes', 13.7% answered 'I am not sure,' and 1.7% answered 'no.' Sixty-four of the parents were not worried about any residual defect in joint or extremity functions related to fracture, whereas 21 were worried and 32 were not sure on this. The rate of searching further information about the child's fracture was 34.2% and the mostly used source was the Internet. Twenty-eight of the 117 respondents (23.9%) emphasized that they would reduce the time their child spend outside the home at least for a while after the removal of cast. When conservatively treating a child's fracture, physicians dealing with traumatology should always consider the parents' perception and behaviors as critically important.
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Huesos de la Extremidad Superior/lesiones , Convalecencia/psicología , Fracturas Óseas , Padres/psicología , Niño , Preescolar , Comportamiento del Consumidor/estadística & datos numéricos , Estudios Transversales , Femenino , Fracturas Óseas/psicología , Fracturas Óseas/terapia , Humanos , Masculino , Recuperación de la Función , Percepción Social , Encuestas y Cuestionarios , TurquíaRESUMEN
Osteoporosis continues to be a major health condition plaguing the aging population. The major manifestation of osteoporosis, the development of fragility fractures, is a burden both clinically and economically on patients and the nation's health care system, with up to half of all American women sustaining a fragility fracture in their older years. The high frequency of injuries to the distal radius and proximal humerus should lead upper extremity surgeons to take pause and recognize the magnitude of impact these fractures have on their patient population. Recommended interventions span a spectrum of aggressiveness and have various financial implications.
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Huesos de la Extremidad Superior/lesiones , Fracturas Osteoporóticas/diagnóstico , Fracturas Osteoporóticas/cirugía , Densidad Ósea , Femenino , Humanos , Masculino , Fracturas Osteoporóticas/etiología , Factores de RiesgoRESUMEN
PURPOSE: This prospective study examined the psychometric properties of the adapted Dutch translation of the Short Musculoskeletal Function Assessment (SMFA) questionnaire in patients with isolated unilateral lower fracture (LEF) or upper extremity fracture (UEF). METHODS: Patients (N = 458) completed the SMFA, WHOQOL-BREF, and the RAND-36 at time of diagnosis (i.e. pre-injury status), 1, and 2 weeks post-fracture. Principal axis factoring was performed, and Cronbach's alpha coefficients (α) and intra-class correlation coefficients (ICC) were calculated. Furthermore, Pearson's product-moment correlations (r), paired t tests, and standardized response means (SRM) were calculated. RESULTS: A three-factor structure was found: Lower extremity dysfunction, Upper extremity dysfunction, and Daily life consequences. This structure was different for patients with LEF versus UEF. ICCs ranged from .68 to .90, and α varied from .81 to .95. The correlations between the SMFA and, respectively, the RAND-36 and WHOQOL-BREF were small to large depending on the SMFA factor combined with fracture location. Responsiveness was confirmed (p < .0001; SRM ranging from .28 to 1.71). CONCLUSIONS: The SMFA has good psychometric properties in patients with fractures. Patients with UEF and LEF could not be regarded as a homogenous group. The development of separate SMFA modules should be considered.
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Huesos de la Extremidad Inferior/lesiones , Huesos de la Extremidad Superior/lesiones , Fracturas Óseas/psicología , Enfermedades Musculoesqueléticas/psicología , Psicometría , Calidad de Vida , Encuestas y Cuestionarios/normas , Adulto , Comorbilidad , Comparación Transcultural , Evaluación de la Discapacidad , Análisis Factorial , Femenino , Fracturas Óseas/diagnóstico , Fracturas Óseas/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Traumatismo Múltiple/diagnóstico , Traumatismo Múltiple/epidemiología , Enfermedades Musculoesqueléticas/diagnóstico , Enfermedades Musculoesqueléticas/epidemiología , Países Bajos/epidemiología , Estudios Prospectivos , Perfil de Impacto de Enfermedad , Traducciones , Evaluación de Capacidad de TrabajoRESUMEN
PURPOSE: To assess the clinical outcome and accuracy of prebent plate fixation in corrective osteotomy for malunited upper extremity fractures using a plastic bone model manufactured by preoperative computer simulation. METHODS: Nine consecutive patients underwent computed tomography (CT)-based 3-dimensional corrective osteotomy for malunited upper extremity fractures. There were 4 cubitus varus deformities, 1 cubitus valgus deformity, and 4 forearm diaphyseal malunions. We constructed a computer model of the affected bones using the CT data and simulated the 3-dimensional deformity correction on a computer. A real-sized plastic model of the corrected bone was manufactured by rapid prototyping. We used a metal plate, prebent to fit the plastic bone model, in the actual surgery. Patients were evaluated after an average follow-up of 22 months (range, 14-36 mo). We retrospectively collected radiographic and clinical data at the most recent follow-up and compared them with preoperative data. We also performed CT after surgery and evaluated the error in corrective osteotomy as the difference between preoperative simulation and postoperative bone model. RESULTS: The range of forearm rotation and grip strength in patients with forearm malunions improved after corrective osteotomies of the radius and ulna. Wrist pain, which 2 patients with forearm malunion had experienced before surgery, disappeared or decreased substantially after surgery. Radiographic examination indicated that preoperative angular deformities were nearly nonexistent after all corrective osteotomies. Three-dimensional errors in the corrective osteotomy using a prebent plate, as evaluated by CT data, were less than 3 mm and 2°. CONCLUSIONS: Prebent plate fixation in corrective osteotomy for malunited upper extremity fractures using a 3-dimensionally corrected, real-sized plastic bone model prepared by preoperative computer simulation is a precise and relatively easily performed technique that results in satisfactory clinical outcome. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
Asunto(s)
Placas Óseas , Huesos de la Extremidad Superior/lesiones , Fracturas Óseas/cirugía , Fracturas Mal Unidas/cirugía , Osteotomía/métodos , Fracturas del Radio/cirugía , Adolescente , Adulto , Niño , Simulación por Computador , Diseño de Equipo , Femenino , Antebrazo/fisiopatología , Fracturas Óseas/diagnóstico por imagen , Fuerza de la Mano , Humanos , Húmero/diagnóstico por imagen , Húmero/lesiones , Imagenología Tridimensional , Masculino , Persona de Mediana Edad , Radiografía , Fracturas del Radio/diagnóstico por imagen , Adulto JovenRESUMEN
Injuries are becoming increasingly prevalent in pediatric athletes. Many of these injuries are diagnosed clinically and do not require imaging for diagnosis, but the sheer increase in numbers of injuries means that radiologists are evaluating more of them. Some injuries that young athletes sustain are simply due to trauma, such as falls, and may be experienced outside sports just as easily; however, others are peculiar to athletic activities. Many of the latter are chronic overuse injuries as opposed to acute injuries and have characteristic appearances. The types of injuries young athletes incur often change based on the stage of skeletal maturity of the patient, and it serves the radiologist well to keep in mind the typical appearances expected at different ages.
Asunto(s)
Traumatismos en Atletas/patología , Extremidad Superior/lesiones , Extremidad Superior/patología , Enfermedad Aguda , Adolescente , Huesos de la Extremidad Superior/lesiones , Huesos de la Extremidad Superior/patología , Cartílago Articular/lesiones , Cartílago Articular/patología , Niño , Trastornos de Traumas Acumulados/patología , Fracturas Óseas/patología , Humanos , Luxaciones Articulares/patología , Ligamentos Articulares/lesiones , Ligamentos Articulares/patología , Imagen por Resonancia Magnética , Osteocondritis Disecante/patología , Traumatismos de los Tendones/patologíaRESUMEN
PURPOSE: Blood flow is an important factor in bone production and repair, but its role in osteogenesis induced by mechanical loading is unknown. Here, we present techniques for evaluating blood flow and fluoride metabolism in a pre-clinical stress fracture model of osteogenesis in rats. PROCEDURES: Bone formation was induced by forelimb compression in adult rats. (15)O water and (18)F fluoride PET imaging were used to evaluate blood flow and fluoride kinetics 7 days after loading. (15)O water was modeled using a one-compartment, two-parameter model, while a two-compartment, three-parameter model was used to model (18)F fluoride. Input functions were created from the heart, and a stochastic search algorithm was implemented to provide initial parameter values in conjunction with a Levenberg-Marquardt optimization algorithm. RESULTS: Loaded limbs are shown to have a 26% increase in blood flow rate, 113% increase in fluoride flow rate, 133% increase in fluoride flux, and 13% increase in fluoride incorporation into bone as compared to non-loaded limbs (p < 0.05 for all results). CONCLUSIONS: The results shown here are consistent with previous studies, confirming this technique is suitable for evaluating the vascular response and mineral kinetics of osteogenic mechanical loading.