Analysis of the factors affecting school attendance in pediatric fractures.

OBJECTIVE: This study aimed to examine the average duration of school absence according to the type of fracture and the factors affecting the duration of absence in children who had difficulty going to school after an acute orthopedic injury. METHODS: Patients between the ages of 6 and 17 who applied to the emergency department of our hospital and were treated for orthopedic trauma during a teaching period between September 2022 and December 2022 were examined. This study was designed prospectively. All school-aged patients with upper or lower extremity fractures requiring hospitalization or outpatient treatment were included in this study. Information about school absences and school starting dates were recorded at the outpatient clinical presentations of these patients. RESULTS: A total of 126 patients were included in this study. The mean age of the patients was 11.7 (range=6-17) years. The gender ratio was determined as F/M=20/106. The average time absent from school was 14.7 (range=2-61) days. Distal radius fractures were the most common upper extremity fractures; the mean time away from school was 7.9 days. In lower extremity fractures, lateral malleolar fracture was the most common complaint, and the mean duration of absence was calculated as 21.8 days. The periods of absence were mainly determined by the family or the child. CONCLUSION: One of the critical findings in this study was that rest periods were primarily determined by the parents and/or the child and not by the physician. The need to use crutches and/or transportation difficulties were other reasons for the absence. For these reasons, teachers and school management should be sensitive to the adverse effects of absenteeism on the child's success and provide facilitating support and home education opportunities when necessary. LEVEL OF EVIDENCE: Level II, Prognostic study.

How Reliable Are Digital Radiographs for Evaluating Intra-articular Displacement in Ankle Epiphyseal Fractures: Can Computed Tomography Be Eliminated?

BACKGROUND: The amount of intra-articular displacement of the fracture is the main issue when deciding the treatment method between conservative or surgical means in intra-articular fractures. In this study, we aimed to determine the intraobserver and interobserver reliability of measuring intra-articular displacement and to compare the digital radiographic and computed tomographic (CT) evaluations in distal tibia intra-articular epiphyseal fractures. METHODS: Thirty-seven patients with digital radiography and CT scans were included in the study. Four sets were prepared with these images. Two of four sets were prepared as ankle radiographs, and the other two sets were prepared with CT scan views. Five observers were asked to measure the intra-articular displacement of the fractures in millimeters and also to make a decision between displacement amounts over or under 2 mm. Intraclass correlation coefficient scores were calculated for evaluation of intraobserver reliability, and Fleiss kappa values were calculated for interobserver reliability evaluations. A value greater than 0.75 was accepted as excellent agreement; 0.75 to 0.40 as intermediate to good agreement; and below 0.40 as poor agreement. RESULTS: There were 15 Salter-Harris type 3, 13 Salter-Harris type 4, seven triplanar, and two Tillaux-Chaput fractures. Both intraobserver and interobserver reliabilities were slightly higher for CT scan evaluations. Amounts of displacement were found to be measured higher after CT scan evaluations other than radiographs. After the measurement of joint displacements on CT scans, it was observed that the measurements found below 2 mm on the digital radiograph measurement changed to greater than or equal to 2 mm in 16.4% of the patients. CONCLUSIONS: This study confirmed that digital radiographs cannot replace CT scans for the measurement of intra-articular displacement in ankle epiphyseal fractures.

Use of the forgotten joint score (FJS)-12 to evaluate knee awareness after isolated anterior cruciate ligament reconstruction with and without meniscus repair or partial meniscectomy.

PURPOSE: The aim of this study was to compare knee awareness, based on the FJS-12 score, among three patient groups: Anterior cruciate ligament reconstruction (ACLR), ACLR + meniscus repair and ACLR + partial meniscectomy. The relationship between FJS-12 scores and scores on other instruments (Lysholm Knee Scoring Scale, Tegner Activity Level Scale, KOOS and WOMAC) was also evaluated. METHODS: Forty-three patients were divided into group A (isolated ACLR) group B (ACLR + meniscectomy) and group C (ACLR + meniscus repair). Graft thickness, femoral tunnel width, tibial tunnel width, tibial screw thickness and follow-up time were evaluated in all three groups. The subjective knee scores (KOOS, WOMAC, Lysholm Knee Scoring Scale, Tegner Activity Level Scale and FJS-12) of the groups were then compared. RESULTS: FJS-12 scores of 43 patients were evaluated. The mean age was 26.1 ± 6.5 years (range: 18-40 years). Group A: 23; group B: 9 and group C include 11 patients. The mean FJS-12 score of group B (median: 100 [range: 98-100]) was higher than that the others. Spearman's rho test showed that the FJS-12 is highly compatible with the other scores. CONCLUSION: According to this study, FJS-12 and the other scoring systems showed that ACLR with partial meniscectomy is the most effective surgical method to restore normal sensation in the knee.

Analysis of the factors that are important in re-displacement in pediatric diaphyseal femur fractures treated with a spica cast.

BACKGROUND: There is no detailed data on the factors affecting the re-displacement in pediatric femoral fractures treated with closed reduction and early spica casting. This study aimed to investigate the factors effective in re-displacement in pediatric diaphyseal femur fractures (PDFF) treated with spica casting. METHODS: In all, 151 displaced PDFF were evaluated retrospectively. Demographic data of the patients were evaluated. Type of fractures, anteroposterior and lateral angulations, amount of shortening, translation ratio, cast index (CI), gap index (GI), and three-point index (TPI) measurements were evaluated radiologically. Thigh flexion angle (TFA) and knee flexion angle (KFA) were measured. After casting, angulation of more than 10° in any plane and a shortening of more than 10 mm was accepted as re-displacement. Binary logistic regression analysis was used to evaluate the risk factors of re-displacement. Receiver operating characteristic analysis was performed for TFA and KFA. RESULTS: Re-displacement was detected in 40 patients (26.5%). Transverse type fracture (p = 0.001), TFA ˂71.4° (p <0.001), and KFA ˂52.6° (p = 0.002) were found to be statistically significant factors on re-displacement. It was determined that the combination of transverse femoral fracture and TFA ˂71.4° increased the probability of re-displacement by approximately 14 times. It has been observed that indices such as CI, GI, and TPI were not effective in predicting the risk of re-displacement. CONCLUSION: When treating a PDFF with spica casting, one should be aware of re-displacement if the fracture type is transverse, TFA is ˂71.4°, and KFA is ˂52.6°. LEVEL OF EVIDENCE: Level III, prognostic.

Ocular blood flow and choroidal thickness in ocular hypertension.

PURPOSE: Ocular hypertension (OHT) is a clinical entity characterized by elevated intraocular pressure (IOP) without optic nerve damage. In the presence of other risk factors, OHT may progress to glaucoma. This study aimed to evaluate ocular blood flow (OBF) and choroidal thickness (CT), which may be markers and/or risk factors that could assess the progression of OHT to glaucoma. MATERIAL AND METHODS: Age and gender matched 60 eyes of 32 patients with OHT and 61 eyes of 31 control patients were included for this study. All participants underwent a detailed ophthalmological examination including best-corrected visual acuity, IOP measurement with Goldmann applanation tonometry, gonioscopy, optic nerve evaluation with 78 D lens, and visual field test with Humphrey visual field analyzer. Retinal nerve fiber layer, ganglion cell complex, and central corneal thickness measurements were performed by optical coherence tomography (OCT). CT was measured with OCT in the fovea, 1.5 mm, 2 mm, 2.5 mm nasal and temporal to the fovea and from nasal and temporal to the optic disk. OBF data including peak systolic velocity (PSV), end-diastolic velocity (EDV), resistivity index (RI) and pulsatility index (PI) were measured with color Doppler imaging (CDI) from the ophthalmic artery (OA), central retinal artery (CRA), medial and lateral branches of short posterior ciliary arteries (MPCA, LPCA). Systolic (SBP) and diastolic arterial blood pressure were also noted. RESULTS: CT measurement at each point in the OHT group compared to the control group were found to be significantly thinner (p = 0.001). There was a decrement in CT from the fovea to the nasal and temporal retina in both groups. In the OHT group, there was a significant decrease in PSV and EDV of OA, CRA, MPCA, and LPCA, and a significant increase in PI and RI of measured arteries. (EDV p = 0.036, PI p = 0.006, RI p = 0.006 for OA and p = 0.001 for other arteries and all OBF measurements). There was a negative correlation between CT and age, IOP and axial length (AL) in OHT group (r = - 0.529, p = 0.001; r = - 0.258, p = 0.047; r = - 0.345, p = 0.007, respectively, for fovea). But there was no statistically significant correlation between CT and other measurements in the control group, except age (r = - 0.860 p = 0.001 for fovea). CONCLUSION: We found that OBF decrement and choroidal thinning in OHT group compared with controls. Interpretation both of CT measurements with OCT and OBF parameters with CDI and new imaging technologies may help to prevent and reduce the possible optic nerve damage.

Efficiency and reporting confidence analysis of sequential dual-energy subtraction for thoracic x-ray examinations.

Rationale and objectives: We aimed to report and compare accuracy, reproducibility, and reporting confidence between thoracic dual-energy subtraction (DES) and routine posterior-anterior chest radiography (PA-CR) techniques. Materials (patients) and methods: We obtained DES (D1-D4) images from 96 patients using DES and a high-resolution dynamic flat-panel detector in combination. We compared the DES images of these patients with their PA-CR images. The maximum time interval between performing DES and PA-CR was nine weeks. Two radiologists evaluated abnormal findings on DES and PA-CR images using a three-point scale, and reporting confidence was scored using a four-point scale. The intra- and interobserver agreement values of the scores were analyzed. Further, the radiation exposure doses during PA-CR and DES acquisitions were calculated. Results: The intra- and interobserver agreement values of PA-CR and DES images were good. The reporting confidence scores for DES were generally higher than those for PA-CR. Between bone-subtracted (D3) and soft-tissue-subtracted (D4) images, the former was more successful and useful in the evaluation of bone structures, whereas the latter was better in the evaluation of consolidation and/or solitary nodules. Conclusions: DES has the potential to improve the accuracy, reproducibility, and reporting confidence of thoracic radiography. It also has the potential to provide a better diagnosis of chest pathologies using relatively low dose radiation.

Scrotal calculi in clinical practice and their role in scrotal pain: A prospective study.

PURPOSE: Scrotal calculi are rare, and their clinical significance is uncertain. Scrotal pain is a frequent, hard-to-manage problem in urology clinics. Our purpose in this study was to determine the relationship between the presence of scrotal calculi and scrotal pain in a prospective manner. METHODS: Sonography and color Doppler ultrasound of the scrotum were performed in 758 consecutive patients referred with scrotal pain. The pain was rated by using an 11-point numeric rating scale; scores were compared among patients with scrotal calculi with and without additional scrotal pathology. RESULTS: Scrotal calculi were detected in 73 of the 758 patients (9.6%). Scrotal pain (n = 50 [61%]) and a palpable mass in the scrotum (n = 25 [30.5%]) were the most common complaints in patients with scrotal calculi. Hydrocele (n = 17 [29.8%]) and varicocele (n = 15 [26.3%]) were the most commonly associated abnormalities; there was a statistically significant association between the presence of scrotal calculi and hydrocele (p < 0.01). Scrotal pain was present in 61 (83.5%) patients with scrotal calculi, and this association was significant (p < 0.001). The presence of scrotal pain and the correlation between location of calculi and pain in patients without additional scrotal abnormalities were also significant (p = 0.04 and p < 0.004, respectively). CONCLUSIONS: The prevalence of scrotal calculi was 9.6%, and hydrocele was found to be associated with scrotal calculi. We also found a significant relationship between the presence of calculi and scrotal pain. Because the etiology of scrotal pain is essential for appropriate treatment, scrotal calculi should be kept in mind when making a differential diagnosis of scrotal pain. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 43:406-411, 2015.