The objective of this study was to assess whether the positioning of the wrist joint in the cast in such a manner that it counteracts the direction of angulation of fragments is more important than ...the cast index in the prevention of secondary displacements in distal forearm fractures. A retrospective review of all pediatric patients (0-16 years of age) who were hospitalized in our institution with displaced fractures of the distal forearm (either isolated fractures of the distal radius or both bone fractures) who underwent subsequent closed reduction and splinting in the period from August 2018 to October 2020. Patients with physeal fractures and open fractures, and skeletally mature patients were excluded from the study. Patients were divided into two categories - the first one in which the cast index was below 0.9 and the second in which it was above 0.9. In each category, we have identified two groups of patients - the first one in whom the wrist joint was positioned in such a manner that it counteracts the direction of angulation of fracture fragments and the second one in whom the wrist joint was in a neutral position. The two groups in each category have been compared according to age, sex, initial angulation, fracture type (isolated radius or both bone fractures), displacement type (angulation or complete dislocation) and the rate of secondary displacement. In both categories, the two groups were comparable according to age, sex, initial angulation, fracture and displacement type. In both categories (cast index below 0.9 and cast index above 0.9), a statistically significant higher portion of patients with secondary displacement was identified in the group of patients who had the wrist joint in a neutral position ( Z = -2.1997; P = 0.0278 - for cast index <0.9 and Z = -2.1672; P = 0.030216 for cast index >0.9). Our research supports the notion that positioning of the wrist joint in the position that counteracts the force that leads to angulation of fracture fragments is more important than the cast index in the prevention of secondary displacements in pediatric distal forearm fractures.
Femur fractures in children can be treated with a number of operative and conservative methods. Numerous factors determine which method is optimal for a specific fracture. The aim of this research ...was to analyze distribution of femur fractures in children living in the urban communities of Zagreb and Zagreb County by localization, type and frequency of treatment methods used according to age and fracture mechanism. The research included 103 children aged up to 18 years, treated for femur fractures at the Zagreb University Hospital Centre and Zagreb Children’s Hospital. Data were collected from these institutions and a retrospective study covered the 2010-2015 period. The cause of fracture and diagnosis were coded with the help of the International Statistical Classification of Diseases and Related Health Problems. Operative treatment was applied in 55% of cases, which is contrary to previous researches. The highest incidence of femur fractures was recorded in the 0- to 4-year age groups, accounting for 49.1% of all fractures. These fractures mostly occurred due to falls and were more often treated with non-operative methods. All other age groups were mostly treated with operative methods. Coxofemoral immobilization and traction were used as non-operative methods, whereas flexible intramedullary nailing was the most frequently used operative method. The treatment depended on age, complexity of the fracture, fracture type, fragment displacement, and associated injuries. The cause was also an important factor on choosing the treatment method. Non-operative treatment was mostly used for fractures caused by falls (64.71% of cases due to falls) and operative treatment was mostly used for fractures caused by traffic accidents (79.4% of cases due to traffic accidents). It is a wide-known opinion that the best treatment for femur fractures in children is non-operative treatment. However, recent studies have shown that the use of operative methods in femur fracture treatment is growing. Our cohort of children treated during a five-year period (2010-2015) also underwent operative treatment more often than non-operative one. Two non-operative and eight operative methods were used. With such a large number of methods, it is clear that there is no unique method for all fractures. However, it is clear that the trend of using operative treatment is connected to the perennial trend of considerable sociodemographic and socioeconomic changes in urban settings such as Zagreb. Lifestyle changes directly affect the prevalence of femur fractures among children, as well as approach to treatment choice. General opinion is that most of fractures that occur at an early age can be treated with non-operative methods. Our research on femur fractures in children confirmed this rule. The youngest age group that had the highest incidence of fractures (49.1% of all fractures) was treated with non-operative methods in 75% of cases. Operative methods prevailed in other age groups. Similar results have been published by other authors. In conclusion, nearly half of all femur fractures (49.1%) occurred at a young age (0-4 years). Diaphysis fractures were most common. Most of the fractures that occurred during the 2010-2015 period were treated with operative methods, mostly in children aged 5-9 years. Out of eight different operative methods, elastic stable intramedullary osteosynthesis was most frequently used (60%). Coxofemoral immobilization and traction were used as non-operative methods.
The problem of low back pain (LBP) in children is very common and many specialists are dealing with it in everyday practice. The cause for low back pain often is not found and classified under the ...diagnosis of non specific low back pain. The objective of this prospective study is to determine wether children with non specific low back pain and existence of anomalies in LS spine (transitional vertebra- TV and/or Spina bifida occulta SBO) also have the degeneration of the intervertebral disc (DD) L4-L5 and/or L5-S1. This prospective study included 69 patients from 8 to 16 years of age (X 12.81) of whom 40 were male (57.97%), and 29 female (42.03%). They all were examinated in University of Zagreb, "Sestre milosrdnice" University Hospital Center, Zagreb Children's Hospital, Department of Orthopaedic, Zagreb, Croatia. The reason of their visit was non specific low back pain. Pain was measured by visual analog scale (VAS) and mean score was three, duration of pain was between two and four weeks. Also, pain was sporadic, during daytime and not connected with level of physical activity. They all have undergone an algorithm of radiological examinations. Standard AP and LL radiographs (RTG) were made, as well as magnetic resonance (MR) of LS spine and sacrum in sagittal and transversal plane in T1 and T2 weighted sequence. The anomalies of L5 and S1 were found in 65 patients: transitional vertebra classified according to Castellvi et al. and SBO. In MRI in T2 weighted sequence DD was found in 61 patients which was classified modified from Pearce. Data analysis and comparison showed that 56patients with TV and/or SBO have changes on vertebral dynamic segment L5-S1 (VDS) and that means DD. In 13 patients only DD or spinal anomaly (TV and/or SBO) were found. Correlation between anomalies and DD in those patients was established by McNemar analysis and has shown significant difference (p=0.581) in favour of the patients with anomaly and DD. This has established that all of 56 patients with spinal anomaly could have DD as known cause of LBP.
Abstract Background Paediatric ankle fractures comprise approximately 4% of all paediatric fractures and 30% of all epiphyseal fractures. Integrity of the ankle “mortise”, which consists of tibial ...and fibular malleoli, is significant for stability and function of the ankle joint. Tibial malleolar fractures are classified as SH III or SH IV intra-articular fractures and, in cases where the fragments are displaced, anatomic reposition and fixation is mandatory. Methods Type SH III–IV fractures of the tibial malleolus are usually treated with open reduction and fixation with cannulated screws that are parallel to the physis. Two K-wires are used for temporary stabilisation of fragments during reduction. A third “guide wire” for the screw is then placed parallel with the physis. Considering the rules of mechanics, it is assumed that the two temporary pins with the additional third pin placed parallel to the physis create a strong triangle and thus provide strong fracture fixation. To prove this hypothesis, an experiment was conducted on the artificial models of the lower end of the tibia from the company “Sawbones”. Each model had been sawn in a way that imitates the fracture of medial malleoli and then reattached with 1.8 mm pins in various combinations. Prepared models were then tested for tensile and pressure forces. Results The least stable model was that in which the fractured pieces were attached with only two parallel pins. The most stable model comprised three pins, where two crossed pins were inserted in the opposite compact bone and the third pin was inserted through the epiphysis parallel with and below the growth plate. Conclusion A potential method of choice for fixation of tibial malleolar fractures comprises three K-wires, where two crossed pins are placed in the opposite compact bone and one is parallel with the growth plate. The benefits associated with this method include shorter operating times and avoidance of a second operation for screw removal.
U ranoj fazi kod opeklinskih ozljeda može se dati samo gruba prognoza o trajanju liječenja. Mi smo stoga proveli analizu povezanosti mehanizma ozljede s omjerom prosječnog trajanja hospitalizacije ...(PTH) i ukupne površine tijela zahvaćenom opeklinom (UPT). Proveli smo retrospektivnu analizu 375-ero pacijenata koji su u razdoblju između 1. siječnja 2010. i 31. prosinca 2019. hospitalizirani zbog opeklinskih ozljeda na Klinici za dječju kirurgiju Klinike za dječje bolesti Zagreb. Pacijenti su s obzirom na mehanizam nastanka ozljede razdijeljeni u sljedeće podskupine - opekline vrućom vodom (n=210), opekline vrućim uljem (n=22), opekline padom u vruću vodu (n=7), kontaktne opekline (n=54), opekline plamenom (n=36), opekline vrućim parama (n=7), eksplozivne opekline (n=13) i opekline strujnim udarom (n=12). Analizirali smo omjer prosječnog trajanja hospitalizacije (PTH) i ukupne površine tijela (UPT) s obzirom na mehanizam opeklinske ozljede. Kontaktne opekline nose veći rizik za veći omjer trajanja hospitalizacije s ukupnom površinom tijela (PTH/UP) od opeklina vrućim uljem (t=2,485, p= 0,015), opeklina vrućom tekućinom (t=3,948, p < 0,001), opeklina plamenom (t= 2,485, p= 0,015), eksplozivnih opeklina (t=2,900, p= 0,005), opeklina zbog pada u vruću vodu (t=4,369, p<0,001) te od opeklina parom (t=4,369, p< 0,001). Opekline plamenom nose veći rizik za veći PTH/UPT omjer od opeklina vrućom tekućinom (t=2,105, p= 0,039), opeklina parom (t=2,848, p= 0,009) te od opeklina nastalih zbog pada u vruću vodu (t=2,846, p= 0,009). Opekline vrućim uljem nose veći rizik za veći PTH/UPT omjer od opeklina parama (t= 2,317, p= 0,029) ili opeklina nastalih zbog pada u vruću vodu (t= 2,263, p= 0,033). Različiti mehanizmi kod opeklinskih ozljeda rezultiraju različitim ishodima što se tiče omjera prosječnog trajanja hospitalizacije i površine tijela zahvaćene opeklinom. U slučaju kontaktnih opeklina može se očekivati najdulje trajanje hospitalizacije s obzirom na ukupnu površinu tijela zahvaćenu opeklinom. Naši rezultati upućuju na to da mehanizam nastanka ozljede ima prognostičku vrijednost u smislu trajanja hospitalizacije.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Fifty patients up to 15 years of age with simple bone cysts were treated at the Department of Pediatric Surgery at the Children's Hospital Zagreb. There were 35 boys and 15 girls with 26 humeral ...cysts, 15 femoral cysts, 8 tibial cysts, and 1 radial cyst. There was one case of multilocularity of a simple bone cyst (in the humerus and femur). Among those cysts, 19 were multicameral (in the femur and humerus). The size of cysts was determined with regard to the length of the affected bone. Cysts involving up to one tenth of the bone length were defined as small, those up to one fifth as medium, and those exceeding one fifth of the bone length as large. Small cysts were followed up, medium ones were treated surgically in case they did not heal after pathologic fracture, and large cysts were treated surgically without delay. The surgery included opening the cyst wall, curetting the wall epithelium, rinsing with peroxide, opening the medullar canal, and filling the cavity with lyophilized bone. If necessary, a thin “old” Küntscher nail was inserted to achieve stability of fragments and to keep the medullar canal free. The medullar canal was opened in 38 surgically treated patients, and there were 36 good results. In the patients who had the medullar canal opened during surgery, there were fewer recurrences. Healing time was shorter than reported in the literature, even more so if the thin Küntscher nail was used.
Chronic abdominal pain (CAP) is a serious medical condition which needs to be approached with great attention. Chronic abdominal pain may be caused by entrapment of cutaneous branches of intercostal ...nerves (ACNES).
The aim of this study is the surgery for abdominal wall pain which caused by cutaneous nerve entrapment in children during last 5 years.
In all children with ACNES, we tried conservative treatment with anesthetic and steroid injections. In children who were refractory to conservative treatment, we received surgical procedure like sectioning the entrapped nerve to obtain relief.
In 12 pediatric patients with chronic abdominal pain, we diagnosed ACNES. Each presented with abdominal pain and a positive Carnett sign. Local nerve blocks using anesthetic and steroid injections are the treatment. In all patients, we tried with local nerve block. In 3 patients, pain improvement occurs in the few minutes, and they were without pain after 5 days. In other 4 patients required a reinjection for pain recurrence. In one patients pain was gone. The maximum reinjection was 3. In other 5 patients, we did operative treatment like sectioning the entrapped nerve.
Some children with CAP have ACNES. In all children with ACNES, we recommended local nerve blocks. If the local block in 3 times is not helping, neurectomy of the peripheral nerve is method of choice.
AIM： To evaluate the role and our experience of injection sclerotherapy with cow milk in the treatment of rectal prolapse in children.
METHODS： In the last 30 years （1976-2006） we made 100 injections ...of sclerotherapy with cow milk in 86 children, In this study we included children who failed to respond to conservative treatment and we perform operative treatment.
RESULTS： In our study we included 86 children and in all of the patients we perform cow milk injection sclerotherapy. In 95.3% （82 children） of patients sclerotherapy was successful. In 4 （4.7%） patients we had recurrent rectal prolapse where we performed operative treatment. Below 4 years we had 62 children （72%） and 24 older children （28%）. In children who needed operative treatment we performed Thiersch operation and without any complications.
CONCLUSION： Injection sclerotherapy with cow milk for treatment rectal prolapse in children is a simple and effective treatment for rectal prolapse with minimal complications.
Femur fractures in children can be treated with a number of operative and conservative methods. Numerous factors determine which method is optimal for a specific fracture. The aim of this research ...was to analyze distribution of femur fractures in children living in the urban communities of Zagreb and Zagreb County by localization, type and frequency of treatment methods used according to age and fracture mechanism. The research included 103 children aged up to 18 years, treated for femur fractures at the Zagreb University Hospital Centre and Zagreb Children's Hospital. Data were collected from these institutions and a retrospective study covered the 2010-2015 period. The cause of fracture and diagnosis were coded with the help of the International Statistical Classification of Diseases and Related Health Problems. Operative treatment was applied in 55% of cases, which is contrary to previous researches. The highest incidence of femur fractures was recorded in the 0- to 4-year age groups, accounting for 49.1% of all fractures. These fractures mostly occurred due to falls and were more often treated with non-operative methods. All other age groups were mostly treated with operative methods. Coxofemoral immobilization and traction were used as non-operative methods, whereas flexible intramedullary nailing was the most frequently used operative method. The treatment depended on age, complexity of the fracture, fracture type, fragment displacement, and associated injuries. The cause was also an important factor on choosing the treatment method. Nonoperative treatment was mostly used for fractures caused by falls (64.71% of cases due to falls) and operative treatment was mostly used for fractures caused by traffic accidents (79.4% of cases due to traffic accidents). It is a wide-known opinion that the best treatment for femur fractures in children is non-operative treatment. However, recent studies have shown that the use of operative methods in femur fracture treatment is growing. Our cohort of children treated during a five-year period (2010-2015) also underwent operative treatment more often than non-operative one. Two non-operative and eight operative methods were used. With such a large number of methods, it is clear that there is no unique method for all fractures. However, it is clear that the trend of using operative treatment is connected to the perennial trend of considerable sociodemographic and socioeconomic changes in urban settings such as Zagreb. Lifestyle changes directly affect the prevalence of femur fractures among children, as well as approach to treatment choice. General opinion is that most of fractures that occur at an early age can be treated with non-operative methods. Our research on femur fractures in children confirmed this rule. The youngest age group that had the highest incidence of fractures (49.1% of all fractures) was treated with non-operative methods in 75% of cases. Operative methods prevailed in other age groups. Similar results have been published by other authors. In conclusion, nearly half of all femur fractures (49.1%) occurred at a young age (0-4 years). Diaphysis fractures were most common. Most of the fractures that occurred during the 2010-2015 period were treated with operative methods, mostly in children aged 5-9 years. Out of eight different operative methods, elastic stable intramedullary osteosynthesis was most frequently used (60%). Coxofemoral immobilization and traction were used as non-operative methods. Key words: Femur; Fracture; Child; Treatment Prijelomi bedrene kosti u djece mogu se lijeciti operativno ili konzervativno. Vise cimbenika utjece na izbor najbolje metode lijecenja ovisno o vrsti prijeloma. Cilj ovoga istrazivanja bio je utvrditi ucestalost prijeloma bedrene kosti u djece na podrucju Grada Zagreba i Zagrebacke zupanije i raspodjelu ucestalosti prema mjestu nastanka, dobi djeteta te vrsti, nacinu nastanka i nacinu lijecenja prijeloma. Istrazivanje je ukljucilo 103 djece u dobi do 18 godina lijecene zbog prijeloma bedrene kosti u Klinickom bolnickom centru Zagreb i Klinici za djecje bolesti Zagreb. Podaci za ovu retrospektivnu analizu su prikupljeni iz navedenih ustanova za razdoblje od 2010. do 2015. godine. Uzroci nastanka prijeloma su sifrirani prema Medunarodnoj klasifikaciji bolesti. Kirursko lijecenje je bilo potrebno u 55% bolesnika, sto nije u skladu s podacima iz prethodnih analiza. Najveca ucestalost prijeloma bedrene kosti bila je u dobnoj skupini od 0 do 4 godine, koja cini 49,1% svih bolesnika. U toj skupini su prijelomi najcesce nastali prilikom pada i vecinom su lijeceni konzervativno. U svim ostalim dobnim skupinama prevladavalo je operativno lijecenje. Najcesce primijenjeni konzervativni nacin lijecenja je bila kokso-femoralna imobilizacija, a najcesci operativni nacin stabilna elasticna osteosinteza titanskim cavlima. Nacin lijecenja je ovisio o dobi, vrsti i slozenosti prijeloma, pomaku ulomaka i udruzenim ozljedama. Uzrok nastanka prijeloma je takoder bio vazan cimbenik u odabiru nacina lijecenja. Konzervativno lijecenje je vecinom primijenjeno kod prijeloma koji su nastali padom (u 64,7% prijeloma nastalih padom), a operativno lijecenje vecinom kod prijeloma nastalih u prometnim nezgodama (79,4% tako nastalih prijeloma je lijeceno operativno). Opce prihvaceno je stajaliste da je konzervativno lijecenje najbolje za dijete. Ipak, u novijim radovima je povecana ucestalost operativnog lijecenja prijeloma bedrene kosti u djece. U nasoj skupini bolesnika lijecenih u razdoblju od 2010. do 2015. godine operativno lijecenje takoder je bilo cesce nego konzervativno. Primijenjena su dva nacina konzervativnog lijecenja i osam nacina operativnog lijecenja. Tako velik broj razlicitih nacina lijecenja pokazuje da ne postoji jedinstvena metoda za lijecenje svih prijeloma. S druge strane, porast ucestalosti operativnog lijecenja je ocito posljedica trajnih socio-demografskih i socio-ekonomkih promjena u urbanim podrucjima poput Zagreba. Promjena nacina zivota izravno utjece na ucestalost prijeloma bedrene kosti, kao i na nacin njihovog lijecenja. Misljenje vecine je da se prijelomi nastali u ranoj dobi uglavnom mogu lijeciti konzervativno. Nase istrazivanje to potvrduje: 75% bolesnika u najmladoj dobnoj skupini, koji su cinili vecinu ozljedenika (49,1%), lijeceni su konzervativno. Operativno lijecenje je prevladavalo u drugim dobnim skupinama, a drugi autori su objavili slicne rezultate. Zakljucno, najmladi bolesnici (u dobi od 0 do 4 godine) cine gotovo polovicu (49,1%) svih bolesnika s prijelomom bedrene kosti. Najcesce mjesto prijeloma je bila dijafiza. Vecina prijeloma u razdoblju od 2010. do 2015. godine lijecena je operativno, vecinom u djece u dobi od 5 do 9 godina. Od osam razlicitih operativnih nacina lijecenja, stabilna elasticna osteosinteza bila je najcesca (60%). Kokso-femoralna imobilizacija ili trakcija bile su najcesci konzervativni nacini lijecenja. Kljucne rijeci: Bedrena kost; Prijelom; Djeca; Lijecenje
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