Clinical Characteristics and Outcomes of Limb Fractures in Saudi Children.

BACKGROUND:  Children's bones are at high risk of fracture as they grow. The clinical characteristics of fractures in children differ from those in adults. Studying fractures in healthy children is critical for identifying cases of fragility fractures. The aim of this study was to assess the clinical characteristics of limb fractures as well as clinical indicators of fracture healing outcomes in healthy Saudi children seen in an emergency room. METHODS: A retrospective review of the treatment course of all pediatric fractures and related factors treated at King Abdullah Specialist Children's Hospital (KASCH) in Riyadh between 2016 and 2018 was conducted. Children with a primary bone disorder or chronic comorbidities known to affect bone health were excluded. RESULTS:  The study included 143 patients (mean age ± SD = 8.23 + 3.76 years), and 71% (n = 102) were males. Motor vehicle accidents (MVAs) were the most common mechanism of injury, accounting for 50 (35%) cases, followed by fall injuries, sports injuries, and pedestrian accidents at 45 (31.4%), 16 (11.2%), and 13 (9.1%), respectively. A total of 178 fractures were reported, with the femur (n = 75, 42.1%) being the most common of the reported fracture sites, followed by the forearm (n = 44, 24.7%). The most common type of fracture was transverse fracture (n = 96, 54% of patients). Vitamin D levels were measured in 53/143 cases. Of these, vitamin D deficiency was found in 38 (71.7%) patients. The average time for fracture healing was 32.9 ± 30.2 weeks. The mechanisms of injury, including MVAs and sports injuries, as well as femur and forearm fractures, were clinical factors that were independently associated with a longer duration of fracture healing time (p < 0.001), but age, gender, and vitamin D status were not associated with that outcome. CONCLUSION:  MVAs and fall injuries were the most common causes of fracture in our patients. MVAs and sports injuries were associated with prolonged healing time. Large prospective, multicenter, or field studies may be required to further explore clinical characteristics, outcomes, and environmental factors.

The Early and Late Postoperative Complications of Pediatric Neuromuscular Scoliosis at King Abdulaziz Medical City, Riyadh, Saudi Arabia: A Case Series.

Background  Neuromuscular Scoliosis (NMS) is defined as "a coronal plane spinal curvature of 10 degrees or more, measured by the Cobb method, in the setting of muscle imbalance secondary to an underlying neuropathic or myopathic disease". Patients who have the disease usually manifest with diminished balance, asymmetrical seating, abnormal gait, and decreased pulmonary function, which are related to the change in spine posture. Surgery benefits patients with NMS in terms of stopping disease advancement and improving quality of life, but is known to be associated with certain complications in this population. The aim of this study is to identify the most common complication in NMS patients after surgical correction. Methods This study is a chart review-based retrospective case series that has covered patients' data going from 2015 to 2019. The study focused on patients who underwent scoliosis correction surgery of both genders and mainly of a single ethnicity, with the inclusion of patients aged 9 to 18 years old. Under consecutive sampling, the study has met a sample size of 14 patients.  Results Most of the study subjects nine (64%) were female. The age median was 13 years (2.25). The highest documented intraoperative complication was blood loss in 11 (79%) patients. The most prevalent early postoperative complication was urinary tract infection in two (14%) patients. No late postoperative complications were documented in the study. Conclusion  The study concluded that blood loss was the most common intraoperative complication. Pulmonary problems were one of the least reported complications. Possible reasons for these findings and prevention methods should be the focus of future studies.

Outcome of diaphyseal pediatric forearm fractures following non-surgical treatment in a Level I Trauma Center.

OBJECTIVES: Pediatric diaphyseal forearm fractures are common injuries of childhood. Conservative modality of treatments is usually preferred when they are possible. We identified factors that may affect closed reduction success or lead to redisplacement in forearm diaphyseal fractures in children. METHODS: This was a retrospective study from a level I trauma center on patients up to 18 years of age who presented with forearm diaphyseal fractures from January 1, 2007, to December 31, 2015. Cases were obtained from medical records. Data were collected and confirmed by plain films and medical files. RESULTS: We included 145 patients in this study. The majority (86.2%) were boys. Around 29% of trials of closed reduction failed, and the patients were subsequently treated surgically. Following trials of closed reduction, 82.4% of both bone cases were successfully reduced compared to 42.9% of radius shaft cases (P = 0.006). Redisplacement following non-surgical treatment in the first follow-up was found in 32% of both bone cases and 13.3% of radial shaft cases. All Galeazzi cases that were successfully treated with closed reduction presented with no redisplacement on follow-up. CONCLUSION: Immediate surgical management might be considered in older children, especially above 12 years of age since they have a higher failure rate of closed reduction than younger ones. Fracture site should be taken into account when following pediatric diaphyseal forearm fractures following conservative treatments as cases with both bone involvement have a high success rate of closed reduction and considerably high rate of redisplacement compared to others.

Patterns of paediatric forearm fractures at a level I trauma centre in KSA.

OBJECTIVES: The current literature does not clearly elaborate the pattern of paediatric forearm fractures. This study aims to identify patterns of paediatric forearm fractures in KSA. METHODS: This retrospective study was conducted in a level I trauma centre. The study population comprised patients up to 18 years of age who presented with forearm fractures between 2007 and 2015. The demographic data of the recruited patients were obtained from medical files, and fractures were identified using plain films. Mean and standard deviations were used for continuous variables, whereas frequencies and percentages were used for categorical variables. RESULTS: This study included 318 patients, ranging in age from 1.2 to 18 years (average: 10.42 ± 4.56 years). The majority were boys (80.8%) and 53.1% were <12 years of age. Girls were significantly more prevalent in the <12-year-old group than in the ≥12-year-old group (p < 0.001). A fall was the mechanism of injury in the majority of patients (82.1%) in the <12-year-old group compared with the ≥12-year-old group (p < 0.001). There was no statistically significant difference in fracture site between the two age groups. The distal forearm was the most common site fractured (47.8%), followed by the distal third of the forearm diaphysis (34.2%). CONCLUSION: Forearm fractures are commonly seen in school-age boys. The distal radius is the most commonly fractured site reported in this study. A fall was the most common mechanism of injury, and safety measures should be implemented in places where children frequently gather.