Orthopedic Injuries in Pediatric Trauma.

BACKGROUND: Trauma remains the leading cause of death in children, of which the majority of patients have orthopedic injuries. The range of injured bones is various, each requiring knowledge and expertise to appropriately manage in a timely fashion. OBJECTIVES: The importance of a systematic approach to the pediatric polytrauma patient is paramount. This chapter will highlight orthopedic issues important to the pediatric polytrauma patient including the unique anatomy and properties of pediatric bone. A systematic approach to the pediatric polytrauma patient will also be discussed. METHODS: A review of the literature was undertaken to identify current practices in pediatric orthopedic trauma care. RESULT AND CONCLUSION: Orthopedic injuries in polytrauma are a common and important entity in children. Special attention to the unique anatomy and injury patterns in children should be undertaken as they are important for their management.

Predictable and Preventable: Historical and Current Efforts to Improve Child Injury Prevention.

BACKGROUND: Childhood injuries are a global epidemic. Accidents resulting in childhood injury and death were first identified as a concern over a century ago. However, "accidents" leading to injury were not recognized as being predictable and preventable until more recently. OBJECTIVES: To describe the worldwide epidemic of childhood injuries, and look at international successes in the field of injury prevention. METHODS: Literature pertaining to injury prevention was reviewed to describe the history of childhood injury prevention, guiding principles of injury prevention, successful strategies for prevention, and future directions. RESULT AND CONCLUSION: Through surveillance, evidence-based injury prevention initiatives, and multi-disciplinary collaboration, we anticipate further reduction in childhood injuries.

Mallet Finger in a Toddler: A Rare But Easily Missed Injury.

A mallet finger is a flexion deformity of a finger at the distal interphalangeal joint due to an injury of the extensor mechanism at the base of the distal phalanx. Most common in middle-aged men, injuries in the pediatric population are less common and rare in toddlers. We describe a case of missed mallet finger and its subsequent treatment in a female toddler.

Skull-Embedded Earring due to a Fall: A Complication and Therapeutic Considerations.

Although earring-related injuries are well described, an earring becoming forcefully embedded in the skull is unusual and has not previously been reported in the literature. We present the case of an 11-year-old child who posed interesting therapeutic considerations given this presentation.

A comparison of the epidemiology of ice hockey injuries between male and female youth in Canada.

BACKGROUND: Hockey is played by youth across Canada, and its popularity has increased dramatically among females in the past decade. Despite this, there has been little epidemiological research comparing the injury patterns of young female and male hockey players. OBJECTIVE: To describe and compare injuries sustained by female and male youth hockey players using the Canadian Hospitals Injury Reporting and Prevention Program database. METHODS: In the present cross-sectional, retrospective comparison study, the Canadian Hospitals Injury Reporting and Prevention Program database was used to identify all hockey-related injuries sustained by children seven to 17.5 years of age over a 15-year period (January 1995 to December 2009). Exclusion criteria included paid professional players and children with injuries sustained while playing road hockey. RESULTS: Inclusion criteria were met by 33,233 children (2637 [7.9%] females and 30,596 [92.1%] males). Compared with males, females reported proportionately more soft tissue injuries (39.8% versus 32.6%; P<0.01) and sprains/strains (21.1% versus 17.6%; P<0.01). Males experienced more fractures (27.1% versus 18.2%; P<0.01) and were most often injured through body checking (42.8% versus 25.7%; P<0.01). Females showed a trend toward increased concussion with age, and were most often injured through collisions (28.6% versus 24.6%; P<0.01). CONCLUSION: Compared with males, female hockey players sustained proportionately more soft tissue injures and sprains/strains, and showed a trend toward concussions in late adolecence. Males experienced more fractures, shoulder injuries and injuries due to body checking. Further research is required to identify risk factors for injury in female youth hockey players and to target injury prevention.

HISTORIQUE: Des jeunes jouent au hockey partout au Canada. La popularité de ce sport a considérablement augmenté chez les filles depuis dix ans. Pourtant, peu de recherches épidémiologiques comparent les profils de blessures des jeunes joueuses de hockey à celui des jeunes joueurs. OBJECTIF: Décrire et comparer les blessures subies par les jeunes joueuses et joueurs de hockey à l'aide des bases de données du Système canadien hospitalier d'information et de recherche en prévention des traumatismes (SCHIRPT). MÉTHODOLOGIE: Dans la présente étude comparative transversale et rétrospective, la base de données du SCHIRPT a permis de dépister toutes les blessures liées au hockey dont ont été victimes des enfants de sept à 17,5 ans sur une période de 15 ans (janvier 1995 à décembre 2009). Étaient exclus les joueurs professionnels rémunérés et les enfants blessés en jouant au hockey de rue. RÉSULTATS: Les critères d'inclusion étaient respectés par 33 233 enfants (2 637 filles [7,9 %] et 30 596 garçons [92,1 %]). Par rapport aux garçons, les filles déclaraient proportionnellement plus de blessures des tissus mous (39,8 % au lieu de 32,6 %; P<0,01) et de foulures ou d'entorses (21,1 % au lieu de 17,6 %; P<0,01). Les garçons subissaient plus de fractures (27,1 % au lieu de 18,2 %; P<0,01), souvent lors de mises en échec (42,8 % au lieu de 25,7 %; P<0,01). Les filles présentaient une tendance à l'augmentation des commotions avec l'âge, et se blessaient davantage lors de collisions (28,6 % au lieu de 24,6 %; P<0,01). CONCLUSION: Par rapport aux joueurs, les joueuses de hockey étaient proportionnellement victimes de plus de blessures des tissus mous et de foulures ou d'entorses, et présentaient une tendance aux commotions à la fin de l'adolescence. Les joueurs subissaient plus de fractures, de blessures à l'épaule et de blessures causées par les mises en échec. D'autres recherches s'imposent pour déterminer les facteurs de risque de blessures chez les jeunes joueuses de hockey et pour cibler les mesures de prévention.

Injury analyses in rural children: comparison of Old-Order Anabaptists and non-Anabaptists.

BACKGROUND: Southwestern Ontario largely comprises rural farming districts and is home to numerous Old-Order Anabaptist settlements. Our objective was to describe the injuries sustained by rural children, both Old-Order Anabaptist and non-Anabaptist, to better target injury prevention programs. METHODS: We retrospectively examined injury data of rural children in Southwestern Ontario with injury severity scores ≥ 12 obtained from hospital and trauma databases (1997-2007). RESULTS: A total of 422 rural children were included in this study: 7.8% Anabaptist (n = 33) and 92.2% non-Anabaptist (n = 389). The age of injured Anabaptist children (median, 7 years; interquartile range = 10) was younger than non-Anabaptist children (median, 14 years; interquartile range = 7; p < 0.001). Anabaptist children were most frequently injured on their property (48.5%; n = 16 of 33; p < 0.001). Non-Anabaptist children were mostly injured on roads (56.8%; n = 221 of 389; p < 0.05) and by motor vehicle collisions (MVCs; 40.1%; n = 156 of 389; p = 0.02). Frequent causes of injury among Anabaptist children were falls (24.2%; n = 8 of 33; p = 0.02), animals (15.2%; n = 5 of 33; p = 0.004), and buggies (9.1%; n = 3 of 33). Approximately half of both groups injured in MVCs did not use seat belts. There were no significant differences between cohorts in sex, injury severity scores, hospitalization days, rates of complications, interventions, comorbidities, or mortality rates. CONCLUSIONS: Injuries to Anabaptist children occur at a young age, primarily on their property, and exhibit a unique spectrum of mechanisms. In contrast, injuries to non-Anabaptist children occur at an older age, primarily on roads, and in MVCs. The use of protective devices was low among all rural children. Development of collaborative injury prevention programs targeted to distinct rural communities, including Anabaptist and non-Anabaptist, are needed for reducing injuries among rural children.

Characterization of extended-spectrum beta-lactamase-producing isolates of Haemophilus parainfluenzae.

OBJECTIVES: To characterize the beta-lactam resistance mechanisms of two clinical isolates of cefotaxime-resistant Haemophilus parainfluenzae recovered from patients in South Africa. METHODS: The relatedness of isolates and plasmids was assessed using PFGE and restriction enzyme analysis, respectively. Plasmid-mediated and chromosomally integrated bla(TEM) genes and ftsI genes were sequenced, and the plasmid-mediated bla(TEM-15) was used to transform a range of control organisms. RESULTS: The two isolates were found to be unique according to PFGE, but had an identical 3.7 kb plasmid encoding a TEM-15 beta-lactamase. Both isolates also had substitutions in penicillin binding protein 3 (PBP3) consistent with substitutions known to exist in beta-lactamase-negative ampicillin-resistant (BLNAR) strains of Haemophilus influenzae. The cefotaxime MICs for control strains of H. influenzae, H. parainfluenzae and BLNAR H. influenzae transformed with the plasmid-mediated bla(TEM-15) were 1.0, 1.0 and 4.0 mg/L, respectively, compared with 16.0 and 8.0 mg/L, respectively, for the two parent H. parainfluenzae. CONCLUSIONS: The high-level cefotaxime resistance in the H. parainfluenzae isolates was due to a combination of a plasmid-mediated TEM-15 extended-spectrum beta-lactamase with altered PBP3 probably contributing. Other contributing resistance mechanisms could not be excluded.

Risk factors for poor bone health in adolescents and adults with CHARGE syndrome.

CHARGE syndrome, is associated with genital hypoplasia, feeding difficulties and delayed puberty. In this study we examined the prevalence of risk factors for poor bone health in adolescents and adults with CHARGE. Questionnaires assessing fracture history, dietary intake of calcium and vitamin D, pubertal status and activity level using the Habitual Activity Estimation Scale (HAES) were completed by caregivers. Control data were collected for the HAES. When available, reports from dual-energy X-ray absorptiometry (DEXA) were obtained. Thirty individuals with CHARGE syndrome (n = 15 males; n = 15 females; age range 13 to 34 years; mean age 19.6 years) were recruited. Traumatic bony fractures were identified in 30% of the population. The recommended nutritional intake (RNI) for calcium and vitamin D were not met by 41% and 87% of the population, respectively, and 53% required past tube feeding. Delayed puberty was experienced by 87% with only 4 individuals (2 female, 2 males) having experienced normal puberty. Hormone replacement therapy (HRT) was taken by 33% of females and 60% of males. According to the HAES, adolescents with CHARGE syndrome (13-18 years) were significantly less active than controls. Individuals with CHARGE syndrome age 19 and older were also less active than controls, although this difference was not significant. DEXA scan data was obtained, however, due to small sample size (n = 10) and confounding variables (i.e., short stature, pubertal stage, height, weight), it was difficult to draw meaningful conclusions. Feeding difficulties, inactivity and hypogonadism are predisposing factors for the development of poor bone health among individuals with CHARGE syndrome. Education is necessary to raise awareness regarding the importance of HRT, proper nutrition and weight-bearing activity for healthy bone development and maintenance in individuals with CHARGE syndrome.