Neglected Monteggia Fractures in Children-A Retrospective Study.

(1) Background: A Monteggia fracture is an infrequent injury in children. It can be missed during an initial consultation in 20-50% of patients. Chronic radial head dislocation may lead to several complications. Thus, surgical reconstruction of chronic Monteggia injuries is justified. The aim of this study is to analyze the single tertiary center experience in the treatment of neglected Monteggia fractures. (2) Methods: A retrospective study of patients treated for missed Monteggia fractures was conducted. Hospital records, operative charts, follow-up records and a set of X-rays were analyzed for each patient. Radiographic results were graded as good, moderate or poor. The functional status of elbows was estimated using the Mayo Elbow Performance Index. (3) Results: A total of 13 patients (8 boys and 5 girls) aged 4-12 years (mean 7.15) were treated during the study period. An angulation osteotomy of the ulna was performed in ten patients and a radial shortening osteotomy in three patients. A Bell-Tawse annular ligament reconstruction was performed in five patients, and a direct repair was performed in two patients. Eight patients had radiocapitellar trans-fixation. There were nine good radiographic results, three moderate and one poor. The functional result was excellent in nine patients, good in three and poor in one. (4) Conclusions: Our work has many limitations (only 13 patients and different types of operations), and conclusions should be drawn very carefully from such a small and diverse group. The surgical reconstruction of neglected Monteggia fractures in children should be attempted in all patients. Angulation and elongation osteotomies of the ulna are suitable for most patients. If there is a marked overgrowth of the radius, gradual ulnar lengthening and radial head reduction using the Ilizarov method may be a better option. Annular ligament reconstruction is not mandatory.

Child Migrant Health: The Role of Pediatric Surgery in the Migrants' Route across Balkan Countries to North-West Europe.

INTRODUCTION: Child migrants are the most vulnerable population, prone to various health conditions due to trauma and the bad living conditions that they experience during their migration. The objective of this study was to determine the pediatric surgical conditions of migrant children treated in our hospital on their way toward North-West Europe. MATERIALS AND METHODS: A retrospective analysis was performed on all admitted migrants in one tertiary and one secondary level hospital from 2016 to 2018. Only migrant children with surgical issues who had been hospitalized or treated in outpatient clinics were included in the study. RESULTS: There were 47 migrants admitted to hospitals and outpatient clinics; 32 from Afghanistan, 11 from Iraq, 1 from Syria, 2 from Iran, and 1 from Algeria. There were 27 boys and 20 girls, average age 7.96 years (range: 3 months-17 years). The average length of hospitalization was 14.1 days (range: 1-48), and average stay in the intensive care unit (ICU) was 7.4 days (range: 1-15). There were 29 migrants treated in outpatient clinics, and 18 were hospitalized. The cause of seeking surgical treatment was trauma in 33 and non-traumatic surgical problems in 14. The most common types of trauma were isolated fractures which occurred in one, followed by isolated head injury in eight. Polytrauma occurred in five. A lethal outcome occurred in one 9-year-old boy from Afghanistan due to severe polytrauma. CONCLUSION: Trauma, predominantly fractures and head injuries, was the leading cause of morbidity in migrant children treated in these two hospitals.

Scaphoid fractures in children.

INTRODUCTION: Scaphoid fractures are rare in childhood. Diagnosis is very difficult to establish because carpal bones are not fully ossified. In suspected cases comparative or delayed radiography is used, as well as computerized tomography, magnetic resonance imaging, ultrasound and bone scintigraphy. Majority of scaphoid fractures are treated conservatively with good results. In case of delayed fracture healing various types of treatment are available. OBJECTIVE: To determine the mechanism of injury, clinical healing process, types and outcome of treatment of scaphoid fractures in children. METHODS: We retrospectively analyzed patients with traumatic closed fracture of the scaphoid bone over a ten-year period (2002-2011).The outcome of the treatment of"acute"scaphoid fracture was evaluated using the Mayo Wrist Score. RESULTS: There were in total 34 patients, of mean age 13.8 years, with traumatic closed fracture of the scaphoid bone, whose bone growth was not finished yet. Most common injury mechanism was fall on outstretched arm--76% of patients. During the examined period 31 children with "acute" fracture underwent conservative treatment, with average immobilization period of 51 days. Six patients were lost to follow-up. In the remaining 25 patients, after completed rehabilitation, functional results determined by the Mayo Wrist Score were excellent. CONCLUSION: Conservative therapy of "acute" scaphoid fractures is an acceptable treatment option for pediatric patients with excellent functional results.

Depression and quality of sleep in maintenance hemodialysis patients.

INTRODUCTION: Sleep disorders and psychological disturbances are common in end-stage renal disease (ESRD) patients. However, despite their frequency and importance, such conditions often go unnoticed, since all patients do not clearly manifest fully expressed symptoms. OBJECTIVE: This study aimed to determine the prevalence of depression and poor sleep quality and to examine the association between these disorders and demographic, clinical and treatment-related characteristics of ESRD patients on hemodialysis (HD). METHODS: The study included 222 patients (132 men and 90 women), mean age 57.3 +/- 11.9 years, from 3 HD centers in Central Serbia, which provided us with biochemical parameters and demographic data. Sleep quality and depression were assessed using the Pittsburgh Sleep Quality Index (PSQI) and Beck Depression Inventory (BDI), respectively. RESULTS: The average BDI was 16.1 +/- 11.3. Depressed patients were significantly older (p=0.041), had a significantly lower dialysis adequacy (p=0.027) and a significantly worse quality of sleep (p < 0.001), while they did not show significant difference as regarding sex, employment, marital status, comorbidities, dialysis type, dialysis vintage, shift and laboratory parameters.The average PSQI was 7.8 +/- 4.5 and 64.2% of patients were poor sleepers. Poor sleepers were significantly older (p = 0.002), they were more often females (p = 0.027) and had a significantly higher BDI (p < 0.001), while other investigated variables were. not correlated with sleep quality. A statistically significant positive correlation was found between BDI and PSQI (r = 0.604; p < 0.001). CONCLUSION: Depression and poor sleep quality are frequent and interrelated among HD patients.

[Evaluation of using Alvarado score and C-reactive protein in diagnosing acute appendicitis in children].

BACKGROUND/AIMS: Acute appendicitis (AA) remains a diagnostic challenge in children, despite ongoing researches. With an aim to facilitate making diagnosis of AA many scoring systems have been created; among them Alvarado score is the most popular. C-reactive protein (CRP) has proven significance for diagnosing AA in adults, but not in children. The aim of this study was to evaluate significance of Alvarado score, as well as CRP values, in making diagnosis of AA in children. METHODS: This prospective six-month study was performed on 257 patients under the age of 15, admitted for acute abdominal pain in the Clinic of Pediatric Surgery and Orthopedics in the Clinical Centre of Nis. Alvarado score and CRP values were determined on admission and compared with final diagnosis on discharge. The patients were divided into two groups: group I--non operated patients with abdominal pain (n=184) and group II--operated on patients for appendectomy (n=73). RESULTS: Values of Alvardo score were statistically significantly different between groups (group I: 4.9 +/- 1.21, group II: 8.55 +/- 1.32). Also, our results showed significantly high values of CRP measured in operated children (group I: 8.17 +/- 4.7 mg/L, group II: 38 +/- 26 mg/L). Values of validity parameters for Alvarado score were: sensitivity 90%, specifity 80%, positive predictive values 87%; for CRP 95%, 70% and 80%, respectively. CONCLUSION: Alvarado score and CRP are very useful adjuvant diagnostic tool for AA to a less experienced surgeon. High values of Alvarado score and CRP cannot be ignored neither at the same time, used as the sole diagnostic method for discriminating children with AA.

[Acute appendicitis in the first three years of life].

Acute appendicitis is the most frequent disease in children population that requires an urgent surgical intervention. Only 2% of operated children belong to the group younger than 3 years. Yet, 77% are school children. Appendicitis in young children is characterized by: atypical clinical course, late diagnosis, high percentage of perforations, and high level of mortality and morbidity rates. The commonest symptoms are: vomiting, undefined abdominal pain, and high temperature. Abdominal distention and diffuse abdominal tenderness are the most frequent signs during examination. Our analysis (1991-2000) included all patients younger than 3 years who were hospitalized in Clinic for Pediatric Surgery Nis with diagnosis of the acute appendicitis. Out of 2533 patients with disease, 58 (2.3%) were younger than 3 years, 23 were girls (39.7%) and 35 were boys (60.3%). Perforated appendicitis was found in 55 (94.8%) of 58 children. Thirty five (60.5%) patients were previously treated. Complications developed in 36 (62.1%) cases: purulence (58.3%), dehiscence (22.3%), abdominal wall abscess (13.8%), and ileus (5.6%). Acute appendicitis is very specific condition that needs high attention by all doctors engaged in pediatric health care. Our recommendation is "to admit and observe" by using the physical examination in all suspected cases. Sometimes, even sedation may be used for better palpation results.

Sexual behavior and sexual function of adults after hypospadias surgery: a comparative study.

PURPOSE: We assessed sexual behavior and sexual function in adults operated on for hypospadias. MATERIALS AND METHODS: Long-term psychosexual adjustment was assessed with a standardized questionnaire which was mailed to 57 patients with hypospadias older than 18 years and 60 age matched normal control subjects. RESULTS: A total of 37 patients with hypospadias and 39 controls participated. Self-reported strength of libido on a scale of 1 to 5 was shown to be similar in the 2 groups. Patients with hypospadias did not have problems in achieving erection and average self-rated quality of erection ranging from 1 to 5 was the same as that of controls (mean value 4.5). Patients with hypospadias noted curvature in a downward direction in a significantly higher proportion compared to controls (40% vs 18%, respectively). There were 13 patients with hypospadias who had ejaculation difficulties, of whom 6 had spraying and 7 had only dribbling of ejaculate. Patients with hypospadias masturbated significantly less often, were significantly less sexually active and had a smaller total number of sexual partners compared to control subjects. Control subjects were significantly more completely satisfied with their sexual life compared to patients with hypospadias (76.92% vs 51.35%, respectively). CONCLUSIONS: Sexual function of patients who underwent surgery for hypospadias in general is not affected. However, there is clearly a difference in certain aspects of sexual behavior between patients with hypospadias and controls. Followup and adequate counselling of patients who underwent surgery for hypospadias in adult life is necessary.