'Trampoline fracture' of the proximal tibia in children: report of 3 cases and review of literature.

We present three cases of fracture of the proximal tibia in young children who were jumping on a trampoline. The typical radiological findings and the underlying mechanism of trauma are discussed. The key radiological features are: a transverse hairline fracture of the upper tibia often accompanied by a buckle fracture of the lateral or medial tibial cortex, buckling of the anterior upper tibial cortex and anterior tilting of the epiphyseal plate. New types of injuries related to specific recreational activities are recognized. It is often helpful to associate a typical injury with a particular activity. Trampoline related injuries have increased dramatically over the last years. The most common lesions are fractures and ligamentous injuries, in particular a transverse fracture of the proximal tibia. However the radiological findings can be very subtle and easily overlooked. It is therefore important to be aware of the typical history and radiological findings.

[Radiologic demonstration of pelvic abscess associated with I.U.D. (Dalkon Shield) in two patients (author's transl)]. / Radiologische diagnose van een pelvisch abces geassocieerd met intra-uteriene contraceptiva (type Dalkon Shield) bij twee patiënten.

PIP: In 2 case reports the radiologic diagnosis of pelvic abscess caused by a Dalkon Shield type IUD was demonstrated. In the 1st case the pelvic abscess was visualized as an impression on the anterior rectal wall and the displacement of the distal 1/3 of the sigmoid. This was confirmed at laparotomy when a Douglas abscess and an inflamed uterus was found. In the 2nd case a segmental narrowing of the rectum and distal 1/3 displacement of the sigmoid were radiographically demonstrated. The spontaneously draining sacrouterine abscess healed with conservative treatment. The Dalkon Shields were removed in both cases. Although the newer IUD's carry less risk of infection this risk is still considerable as reported in the literature. A 1978 review of 6 epidemiologic studies points to a 3 to 5-fold higher risk of pelvic infection with IUD use. This risk may be higher for women without previous pregnancy and may drop to a low of 1.7 in women with previous pregnancy. Some authors point to a higher risk of adnexitis with the Dalkon Shield compared to other types of IUDs. The Dalkon Shield has been removed from the market in the US and other countries after a US publication of 35 fatalities caused by sepsis in IUD users.^ieng