Bryant traction in paediatric femoral shaft fractures, home traction versus hospitalisation.

AIM: To evaluate Bryant traction at home in terms of feasibility, morbidity, effect on length of hospital stay, outcome and costs. PATIENTS AND METHODS: Retrospective analysis of 54 children treated for femoral shaft fracture (1991-2004). Results of 'home traction' (A, n=38) and 'hospital traction' (B, n=16) were compared. Data were collected regarding demographics, length of hospital stay, traction period, various aspects of the fractures, co-morbidity, morbidity, and follow-up. The parents' experience was evaluated by telephone questionnaire. RESULTS: Two early treatment failures occurred. One patient stopped home traction at 8 days due to skin problems and had a spica cast applied at another hospital, with subsequent development of a compartment syndrome. The other patient was placed in a hip spica after 2 weeks of hospital traction because of difficulty in getting satisfactory X-rays. At follow-up, one unacceptable shortening of 3 cm had occurred in the home traction group. There was only a significant difference in hospital stay (A 7.0 days versus B 22.5 days), total traction period (A 28.0 days versus B 22.5 days) and costs (group B 3x versus group A). The parents were overall pleased with traction at home. Complications occurred as much in the home traction group as in the control group and fracture position at union was equal in both groups. CONCLUSIONS: Treatment with home traction is feasible, simple and effective; it reduces hospital stay to 1 week, and costs to one-third. Good patient selection and instructions of the parents are mandatory.

[Femoral shaft fracture in children younger than 4 years: shorter hospital stays with the help of at home traction apparatus]. / Femurschachtfractuur bij kinderen jonger dan 4 jaar: kortere ziekenhuisopname met behulp van tractie thuis.

OBJECTIVE: Evaluation of home traction as a treatment as a treatment of femoral shaft fractures in children with the objective to shorten the hospital stay. DESIGN: Retrospective. SETTING: Paediatric Surgical Centre Amsterdam (EKZ/AMC and AZVU), the Netherlands. METHOD: In the period 1991-1995, 18 femoral shaft fractures in children younger then 4 years were treated. In ten of them traction was applied at home (in the other cases the parents refused to co-operate, the home situation was not appropriate, there were additional medical problems or there was a suspicion of child abuse). During follow-up of the group treated at home with traction, angulation, deformity and leg length discrepancy were determined with special attention to complications. The parents' experience of this method was evaluated by telephone (n = 8). RESULTS: The median age of the children was 2.4 years. The mean hospital stay was 7 days (range: 3-12), the mean follow-up 2.4 years (range: 1.0-4.3). Angulation, rotational deformities and leg length discrepancy > 1 cm did not occur. Oedema and pain were seen in 1 patient as a result of incorrect treatment at home. In one patient a compartment syndrome occurred after a switch from traction to a plaster treatment in another hospital. With exception of some small practical and informational problems, parents were very pleased with this method. CONCLUSION: Treatment at home of femoral shaft fractures in children with traction is a simple and effective method which reduces the hospital stay to one week with minimal complications. Good patient selection and instructions of the parents are mandatory.

Sirius red histophotometry and spectrophotometry of sections in the assessment of the collagen content of liver tissue and its application in growing rat liver.

By means of staining with Sirius Red F3BA in a saturated picric acid solution, the collagen contents of rat livers with varying degrees of fibrosis have been measured quantitatively in fixed and sectioned material, using both histophotometry in situ and extraction of bound dye with colorimetric analysis. These findings have been correlated with chemical assays of the hydroxyproline content in homogenates from the same livers. It appears that a highly significant correlation exists between both section-based analysis methods and the hydroxyproline content, the Spearman-Rank correlation coefficients being virtually identical. For analysis of collagen accumulation in rat liver, both section-based methods seem to be useful and reliable, the extraction method giving the quickest results for large-scale screening, and the histophotometric method being more appropriate to take readings in selected areas. With human liver material, indications have been obtained for the existence of large sampling errors due to inhomogeneous distribution of collagen deposits. Using the extraction method, no significant changes could be observed in the volume density of collagen during postnatal growth from 1 week to 21 months in rat liver: only on the third day after birth was a higher value of collagen/total protein obtained, possibly due to a higher water content of the hepatocytes. Partial hepatectomy was found to have no influence at all on the collagen content of rat liver during the period of restorative growth or after it.

Giardiasis in childhood: an unnecessarily expensive diagnosis.

In 70 patients with proven giardiasis the efficacy and cost-effectiveness of the diagnostic procedure were studied retrospectively. In 53% of the patients, complaints existed for more than 6 months. Parasitological examination of three stool specimens on non-consecutive days showed a sensitivity of 95.7%. The false negative rate was 2.8%, as giardiasis was found in 3 out of 109 patients in whom duodenal biopsy was performed after a negative "triple faecal test". Of other laboratory investigations performed before the results of faecal screening were known, 75% gave normal results, thus not contributing to the diagnosis. A proposal for a cost-effective diagnostic procedure is presented.