Search

The aim of this study was to identify seasonal variation in nonaccidental injury (NAI) in children <1 year of age. Fifty consecutive patients age ≤12 months with a fracture were identified between January 2010 and June 2012. Patients' records were reviewed for demographic, clinical, and radiographic data. Zip code was used to collect socioeconomic data. Out of 50 patients included in the study, fractures in 16 (32%) patients were reported for abuse. NAI was reported in 2/13 (15%) fracture cases presenting in the spring, 5/6 (83%) in summer, 6/15 (40%) in autumn, and 3/14 (21%) in winter. The ratio of NAI to accidental injury was highest in the summer. Presentation in summer was associated with NAI ( P < .001). In addition, NAI was associated with parental unemployment, single parents, and lower socioeconomic status ( P < .001). Seasonal variation occurred, and the most common season for NAI was the summer; also, NAI in children <1 year of age was associated with parental unemployment, single parent, and poverty.

Objectives: To establish the incidence, mortality rate, and fracture location of pediatric patients injured while using an all-terrain vehicle (ATV) over an 11-year period., Methods: A retrospective study using a state trauma database for patients ages 0 to 17 years who sustained injuries while using an ATV. Thirty-two pediatric and adult trauma centers within the state were evaluated from January 1, 2004, to December 31, 2014., Results: The inclusion criteria were met by 1912 patients. The estimated mean annual incidence during the period of the study was 6.2 patients per 100 000 children in the pediatric population <18 years of age. There was a decrease of 13.4% in the mean incidence when comparing the first 5 years of the study with the last 6 years. The median age of patients was 14 years. The median hospital length of stay and injury severity score were 3 days and 9, respectively. There were 28 fatalities (1.5%). The mean mortality incidence was 0.09 deaths per 100 000 children and remained relatively constant. The majority of patients (55.4%) sustained at least 1 bone fracture at or below the cervical spine. The femur and tibia were more commonly fractured (21.6% and 17.7% of the patients, respectively)., Conclusions: Despite current guidelines by the American Academy of Pediatrics, patients younger than 16 years of age remain victims of ATV injuries. Although there was a 13.4% reduction in the incidence of ATV-related injuries in recent years, continued preventive guidelines are still necessary to avert these injuries in children and adolescents., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2017 by the American Academy of Pediatrics.)

The clavicle is the most commonly fractured bone. Children with simple fractures are often referred to orthopedic surgeons by primary care physician to ensure adequate care. The objective of this study was to show that simple clavicle fractures have excellent outcomes and are within the scope of primary care physician's practice. We performed a retrospective chart review of 16 adolescents with simple clavicle fractures treated with a sling. Primary outcomes were bony union, pain, and function. The patients with simple clavicle fractures had excellent outcomes with no complications or complaints of pain or restriction of their activities of daily living. The outcomes are similar whether treated by an orthopedic surgeon or a primary care physician. The cost to society and the patient is less when the primary care physician manages the fracture. Therefore, primary care physicians should manage simple clavicle fractures.

Background: Previous literature has underreported radiation exposure with the use of mini C-arm during pediatric forearm fracture reductions. The purpose of this study is to report an accurate amount of radiation exposure during fracture reductions using a mini C-arm that records the amount of kilovolts, milliamps, and the number of seconds of foot pedal use., Methods: Eighty-six consecutive pediatric patients undergoing upper extremity fracture reduction in the emergency department were studied. The orthopaedic resident, either a PGY2 or PGY3, performed a manipulative reduction and casting of the fracture with use of the mini C-arm. Postreduction, in cast, anteroposterior and lateral images from the mini C-arm were saved to the computerized radiology system. The mini C-arm recorded the amount of kilovolts, milliamps, and the number of seconds that the foot pedal was used for each reduction. A radiology physicist (S.K.) calculated the amount of millirem (mR) exposure for each reduction from these data., Results: The resident using the mini C-arm and the fracture pattern affected the amount of radiation exposure. The average mini C-arm mR exposure for distal radius fractures was 63 mR; forearm 109 mR; elbow 53 mR; and hand 69 mR. For comparison, conventional anteroposterior/lateral forearm radiographs emit an average of 20 mR. Less-experienced PGY2 residents had a higher mR exposure per reduction compared with PGY3 residents., Conclusions: Radiation exposure when using the mini C-arm for reduction of pediatric fractures has been underestimated in previous literature. Radiation from the mini C-arm exceeded that from conventional radiographs in most cases. We recommend that residents receive training about the use of the mini C-arm before its utilization as an aid to reduce pediatric fractures in the emergency department.

Fractures of the neck of the phalanx of the finger are uncommon, but problematic, injuries in children. Displaced fractures may heal with malunion leading to loss of movement or angular deformity. Remodelling of the phalangeal neck is reported to be minimal because of the distance of the fracture from the physis. We report three displaced fractures in two children who presented late. The fractures were treated conservatively and remodelled completely. Both patients regained full movement of the fingers.

Seventy-eight fractures are reported in 61 children who fell while in-line skating. Distal radius or radius and ulna fractures as a result of falls on the outstretched hand occurred in > 75% of cases. Almost half of the patients were novices with < 4 weeks of experience on in-line skates. In fact, one in eight children sustained a fracture during the first attempt at the sport. Closed reductions were needed in 26 cases. Only two of 61 children were wearing any protective equipment at the time of the fracture.

We prospectively studied the efficacy and safety of self-administered nitrous oxide combined with a hematoma block in 100 children who had a closed reduction of a fracture in the emergency department. No child was excluded from the study because of the type of fracture. The average Children's Hospital of Eastern Ontario pain score (CHEOPS), as determined by the emergency-medicine physician who observed the reduction, was 6.8 points (range, 4 to 12 points). The average grade for pain, as recalled by the patient and indicated on a visual-analogue pain scale that ranged from 0 to 10 points, was 6.5 points before the patient received any analgesia and 1.2 points immediately after reduction of the fracture and application of a cast. Ninety-seven patients obtained an analgesic effect from the combination of nitrous oxide and a hematoma block. The three remaining children obtained no effect, and the fracture was reduced with use of general anesthesia. Three additional reductions were technically unsuccessful because of rotational or angular malalignment, and a second reduction was performed with general anesthesia. There were no complications such as vomiting, respiratory depression, a change in the oxygen-saturation level, infection, or nerve injury. We concluded that self-administration of nitrous oxide combined with use of a hematoma block is a safe and effective technique of analgesia for the outpatient reduction of fractures in children.

We prospectively studied the efficacy and safety of self-administered nitrous oxide analgesia for 54 children undergoing closed reductions of fractures in the emergency department. No child was excluded from entry into the study because of fracture type. Nitrous oxide was the sole source of analgesia. The average Children's Hospital of Eastern Ontario pain score (CHEOPS) rated by the emergency medicine physician observing the reduction was 9.1 (range 6-13). Ninety-one percent of children obtained an analgesic effect; however, 46% of children had a CHEOPS score of > or = 10, indicating significant pain. A statistically significantly higher proportion of failures using nitrous-oxide analgesia occurred in patients with completely displaced radius/ulna fractures (p = 0.027). No complications such as vomiting, respiratory depression, or a change in oxygen saturation resulted from the use of nitrous oxide.

Injuries resulting from rocking soda vending machines are severe and potentially fatal. Four cases of significant trauma stemming from soda vending machine accidents are reported: One patient died, one is disabled, and two healed uneventfully. As a result, we recommend securing heavy soda vending machines to prevent further injuries. To our knowledge, this is the first report on a mechanism of injury resulting from soda machines.