How common are refractures in childhood?

Aims: The aim of this study was to describe the incidence of refractures among children, following fractures of all long bones, and to identify when the risk of refracture decreases. Methods: All patients aged under 16 years with a fracture that had occurred in a bone with ongoing growth (open physis) from 1 May 2015 to 31 December 2020 were retrieved from the Swedish Fracture Register. A new fracture in the same segment within one year of the primary fracture was regarded as a refracture. Fracture localization, sex, lateral distribution, and time from primary fracture to refracture were analyzed for all long bones. Results: Of 40,090 primary fractures, 348 children (0.88%) sustained a refracture in the same long bone segment. The diaphyseal forearm was the long bone segment most commonly affected by refractures (n = 140; 3.4%). The median time to refracture was 147 days (interquartile range 82 to 253) in all segments of the long bones combined. The majority of the refractures occurred in boys (n = 236; 67%), and the left side was the most common side to refracture (n = 220; 62%). The data in this study suggest that the risk of refracture decreases after 180 days in the diaphyseal forearm, after 90 days in the distal forearm, and after 135 days in the diaphyseal tibia. Conclusion: Refractures in children are rare. However, different fractured segments run a different threat of refracture, with the highest risk associated with diaphyseal forearm fractures. The data in this study imply that children who have sustained a distal forearm fracture should avoid hazardous activities for three months, while children with a diaphyseal forearm fracture should avoid these activities for six months, and for four and a half months if they have sustained a diaphyseal tibia fracture.

Continued growth after fixation of slipped capital femoral epiphysis.

PURPOSE: When treating slipped capital femoral epiphysis (SCFE), a smooth pin with a hook or a short threaded screw can be used to allow further growth, which could be important to prevent the development of impingement and early arthritis. The purpose of this investigation was to measure growth in three dimensions after fixation of SCFE. METHODS: Sixteen participants with unilateral SCFE, nine girls and seven boys with a median age of 12.0 years (range 8.4-15.7 years), were included. The slipped hip was fixed with a smooth pin with a hook, and the non-slipped hip was prophylactically pinned. At the time of surgery, tantalum markers were installed bilaterally on each side of the growth plate through the drilled hole for the pin. Examination with radiostereometric analysis (RSA) was performed postoperatively and at 3, 6 and 12 months. The position of the epiphysis in relation to the metaphysis was calculated. RESULTS: At 12 months, the epiphysis moved caudally, median 0.16 mm and posteriorly 2.28 mm on the slipped side, in comparison to 2.28 cranially and 0.91 mm posteriorly on the non-slipped side, p = 0.003 and p = 0.030, respectively. Both slipped and non-slipped epiphysis moved medially, 1.52 and 1.74 mm, respectively. A marked variation in the movement was noted, especially on the slipped side. CONCLUSIONS: The epiphysis moved in relation to the metaphysis after smooth pin fixation, both on the slipped side and on the prophylactically fixed non-slipped side, implying further growth. The RSA method can be used to understand remodelling after 'growth-sparing' fixation of SCFE.

Children in Sweden admitted to intensive care after trauma.

OBJECTIVE: The aims of this study were to describe the demographics, injuries, mechanisms and severity of injury, prehospital and hospital care during the first 24h, and patient outcome, in the most severely injured children cared for following trauma at a paediatric intensive care unit in Sweden. METHODS: The medical records of 131 traumatised children (0-16 years of age), admitted to the paediatric intensive care unit in Gothenburg from January 1990 to October 2000, were retrospectively examined. Nine internationally recognised scoring systems were used to calculate severity of injury, in order to predict the chances of patient survival. RESULTS: Paediatric trauma was more common in boys (68%). The mean age at injury was 7.9 years (S.D. 4.7 years). Traffic-related accidents (40%) and falls (34%) were the leading causes of injury. Injuries to the head were the most frequent, forming 24% of all injuries. Severity of injury was recorded as an Injury Severity Score median of 14, Trauma Score Injury Severity Score median of 99% and Paediatric Risk of Mortality Score median of 0.69%. The mortality rate was 3%. CONCLUSION: Trauma with admission to a paediatric intensive care unit is rare in a Swedish paediatric population. When cared for at a centre with the necessary facilities and trained personnel, these children have a good chance of survival.

Major trauma with multiple injuries in Swedish children.

OBJECTIVE: To describe the demographics, mechanisms, pattern, and severity of injury, the prehospital and hospital care during the first 24 hours, and the outcome in the most severely injured children in a paediatric intensive care unit (PICU). DESIGN: Retrospective review. SETTING: Paediatric intensive care unit (PICU), Sweden. SUBJECTS: 45 children (0-16 years of age) with multiple injuries admitted to the PICU in Gothenburg from January 1990 to October 2000, inclusive. MAIN OUTCOME MEASURE: Mortality within 30 days after injury. RESULTS: About 2/100000 children with multiple injuries were admitted to the PICU from the greater Gothenburg area each year from 1990-2000 inclusive. Injuries were more common in boys (n = 29, 64%). The mean age was 7 years (SD 5). Traffic related events (n = 29, 64%) and falls (n = 11, 24%) were the leading causes of injury. Thoracic and abdominal injuries were the most common (17% and 16% respectively). Three children died. CONCLUSION: Major trauma with multiple injuries is rare in Swedish children. When they are cared for at a centre with the necessary facilities and trained personnel they have a good chance of survival.