ABSTRACT
AIM: Paediatric gastrointestinal injuries (GIIs) are rare, and the aim of this multicentre study was to evaluate their outcomes in a large cohort. METHODS: Hospital databases of 10 European paediatric surgical centres were reviewed for paediatric traumatic GIIs managed between 2000-2010. RESULTS: Ninety-seven patients with a median age of 9 years (0-17 years) were identified, with 72 blunt and 25 penetrating GIIs. Initial diagnostics in 90 patients led to correct diagnosis in 71%. Diagnostics were delayed in 26 patients (median 24 h). Eighty-two patients required surgery (67 laparotomy, 12 laparoscopy and three other approaches). There was a 50% conversion in the laparoscopic group. Median hospital stay was 10 days (range 1-137 days), with longer duration influenced by associated injuries (n = 41). Diagnosis <24 h was associated with significantly shorter hospital stay compared to more than 24 h (p = 0.011). In one-third of patients, morbidities were not related to a diagnostic delay or type of injury. There were five lethal outcomes, four due to associated injuries. CONCLUSION: Initial diagnostics in traumatic paediatric GIIs provide false negatives in one-third of patients. Diagnostic delay <24 h is associated with a significantly shorter hospital stay. Although laparoscopy is associated with a conversion rate of 50%, it can be used for diagnosis in suspected cases to avoid nontherapeutic laparotomy.
Subject(s)
Gastrointestinal Tract/injuries , Wounds, Nonpenetrating/diagnosis , Wounds, Nonpenetrating/therapy , Wounds, Penetrating/diagnosis , Wounds, Penetrating/therapy , Adolescent , Child , Child, Preschool , Conversion to Open Surgery/statistics & numerical data , Delayed Diagnosis/statistics & numerical data , Europe/epidemiology , False Negative Reactions , Female , Gastrointestinal Tract/surgery , Humans , Infant , Infant, Newborn , Laparoscopy/statistics & numerical data , Laparotomy/statistics & numerical data , Length of Stay/statistics & numerical data , Male , Retrospective Studies , Treatment Outcome , Wounds, Nonpenetrating/etiology , Wounds, Nonpenetrating/mortality , Wounds, Penetrating/etiology , Wounds, Penetrating/mortalityABSTRACT
Matrix metalloproteinases (MMPs), responsible for extracellular matrix remodelling and angiogenesis, might play a major role in the response of the growth plate to detrimental loads that lead to overuse injuries in young athletes. In order to test this hypothesis, human growth plate chondrocytes were subjected to mechanical forces equal to either physiological loads, near detrimental or detrimental loads for two hours. In addition, these cells were exposed to physiological loads for up to 24 hours. Changes in the expression of MMPs -2, -3 and -13 were investigated. We found that expression of MMPs in cultured human growth plate chondrocytes increases in a linear manner with increased duration and intensity of loading. We also showed for the first time that physiological loads have the same effect on growth plate chondrocytes over a long period of time as detrimental loads applied for a short period. These findings confirm the involvement of MMPs in overuse injuries in children. We suggest that training programmes for immature athletes should be reconsidered in order to avoid detrimental stresses and over-expression of MMPs in the growth plate, and especially to avoid physiological loads becoming detrimental.
Subject(s)
Chondrocytes/metabolism , Cumulative Trauma Disorders/etiology , Growth Plate/cytology , Matrix Metalloproteinase 13/biosynthesis , Matrix Metalloproteinase 2/biosynthesis , Matrix Metalloproteinase 3/biosynthesis , Weight-Bearing/physiology , Child, Preschool , Female , Humans , Infant , MaleABSTRACT
BACKGROUND: One of the complications of forearm shaft fracture is refracture. Elastic stable intramedullary nailing represents an alternative method for refracture treatment to cast immobilisation for another five to seven weeks. Operative treatment often necessitates an open reduction in most cases due to blocked or narrowed medullary canals. The purpose of this study was to examine the expense of the operative procedure, technique (closed or open intramedullary nailing) and postoperative complications in diaphyseal forearm refractures. METHODS: We retrospectively examined the expense of operative procedure in 21 children with diaphyseal forearm refractures treated with ESIN. RESULTS: In 18 cases, closed reduction with nailing was possible; three required an open reduction. In nine patients a closed medullary cavity was present; only two of them needed an open reduction. None of the patients had complications (wound healing, osteomyelitis, rupture of the extensor pollicus longus). Swelling appeared in four patients, paraesthesia of the thumb in one. Free functional movement was achieved in all children. Long term results: No re-refracture occurred. One patient suffered from meteorosensitivity. Twelve are able to do the same sporting activities as before injury. CONCLUSION: ESIN seems to be one choice for treatment in refracture of the forearm, as in most cases the operative reduction can be performed in a closed way by means of "tricks and hints".
