Aims. The aim of this study is to develop a core set of outcome domains that should be considered and reported in all future trials of childhood limb fractures. Methods. A four-phase study was conducted to agree a set of core outcome domains. Identification of candidate outcome domains were identified through systematic review of trials, and outcome domains relevant to families were identified through semi-structured interviews with 20 families (parent-child pairing or group). Outcome domains were prioritized using an international three-round Delphi survey with 205 panellists and then condensed into a core outcome set through a consensus workshop with 30 stakeholders. Results. The systematic review and interviews identified 85 outcome domains as relevant to professionals or families. The Delphi survey prioritized 30 upper and 29 lower limb outcome domains at first round, an additional 17 upper and 18 lower limb outcomes at second round, and four additional outcomes for upper and lower limb at the third round as important domains. At the consensus workshop, the core outcome domains were agreed as: 1) pain and discomfort; 2) return to physical and recreational activities; 3) emotional and psychosocial wellbeing; 4) complications from the injury and treatment; 5) rturn to baseline activities daily living; 6) participation in learning; 7) appearance and deformity; and 8) time to union. In addition, 9a) recovery of mobility and 9b) recovery of manual dexterity was recommended as a core outcome for lower and upper limb fractures, respectively. Conclusion. This set of core outcome domains is recommended as a minimum set of outcomes to be reported in all trials. It is not an exhaustive set and further work is required to identify what outcome tools should be used to measure each of these outcomes. Adoption of this outcome set will improve the consistency of research for these children that can be combined for more meaningful meta-analyses and policy development. Cite this article:
Aims. The aim of this study is to evaluate the surgical treatment with the best healing rate for patients with proximal femoral unicameral
In 79 consecutive patients with unicameral
Aims. Preserving growth following limb-salvage surgery of the upper
limb in children remains a challenge. Vascularized autografts may
provide rapid biological incorporation with the potential for growth
and longevity. In this study, we aimed to describe the outcomes
following proximal humeral reconstruction with a vascularized fibular
epiphyseal transfer in children with a primary sarcoma of
Aim. To study the results of using recombinant human
Permanent growth arrest of the longer
Forearm fractures in children have a tendency
to displace in a cast leading to malunion with reduced functional
and cosmetic results. In order to identify risk factors for displacement,
a total of 247 conservatively treated fractures of the forearm in
246 children with a mean age of 7.3 years (. sd. 3.2; 0.9
to 14.9) were included in a prospective multicentre study. Multivariate
logistic regression analyses were performed to assess risk factors
for displacement of reduced or non-reduced fractures in the cast.
Displacement occurred in
73 patients (29.6%), of which 65 (89.0%) were in above-elbow casts.
The mean time between the injury and displacement was 22.7 days
(0 to 59). The independent factors found to significantly increase
the risk of displacement were a fracture of the non-dominant arm
(p = 0.024), a complete fracture (p = 0.040), a fracture with translation
of the ulna on lateral radiographs (p = 0.014) and shortening of
the fracture (p = 0.019). Fractures of both forearm
The aim of limb-salvage surgery in malignant bone tumours in children is to restore function and eradicate local disease with as little morbidity as possible. Allografts are associated with a high rate of complications, particularly malunion at the allograft-host junction. We describe a simple technique which enhances union of allograft to host
Purpose of study. The aim of this study is to evaluate the role of low intensity pulsed ultrasound, Exogen in the treatment of delayed and non unions. Methodology: We conducted a retrospective study of 292 patients who has had Exogen treatment for delayed and non union from 2005 to 2009. Patient's age, sex, associated co morbidities, smoking history, medications, type of fractures (open/closed), infection and site of fractures were sought for. 271 patients' data (228 delayed and 43 non unions) were available during the study with mean age of 53.5 yrs. Exogen therapy was initiated at 3–4 months for delayed unions and 6–12 months for non unions in 61 tibia (15 open); 31 femur (2 open); 20 scaphoid; 38 5th metatarsal; 31 ankle (2 open); 17 ulna (1 open); 15 radius (3 open); 29 humerus (2 open); 16 clavicles; 6 olecranon; 4 pilon (2 open) and 2 metacarpal fractures. Discussion. Union was achieved in 196 patients (72.3%) of which 11 (5.6%) were smokers. In 73 (26.9 %) patients union was not achieved of which 53 (72 %) were smokers. The mean healing timing after application of Exogen was 16 weeks for delayed union and 26.6 weeks for non union. 5 (31.2%) pt out of 16 in the DM group went into non union. Conclusion. In our study we found an accelerated union rate with Exogen therapy in delayed union, however smoking is a negative predictor for
We prospectively evaluated the percutaneous injection of autogenous
Background. Unicameral
Purpose. Analyze the results of reconstruction of post osteomyelitic
The use of recombinant human
The management of chronic osteomyelitis requires the excision of necrotic and infected material followed by the prolonged administration of antibiotics. Sequestrectomy may be required before an involucrum has formed, resulting in a longitudinal
Congenital pseudarthrosis of the tibia is an uncommon manifestation of neurofibromatosis type 1 (NF1), but one that remains difficult to treat due to anabolic deficiency and catabolic excess. Bone grafting and more recently recombinant human
Fractures are the second commonest presentation of non-accidental injury (NAI) in children. Approximately one third of abused children will present to Acute Trauma Services (ATS) with fractures. Any cases of suspected child maltreatment should be referred to Safeguarding Services for follow-up, as outlined by Trust Guidelines. Our aim was to examine the referral of children with suspicious fractures to safeguarding and assess if cases with high risk of abuse are being missed by ATS. A comprehensive literature review identified commonly cited indicators of abuse. Inclusion criteria included age less than 18 months seen in A&E or Fracture Clinic with a long bone fracture. Patient notes were analysed to identify occurrence of these risk factors and findings cross-referenced with Safeguarding Services' records to verify whether high-risk patients were detected. The origin of each referral was also noted.Aim
Method
Aims. The aim of this study was to describe the incidence of refractures among children, following fractures of all long
Aims. Given the possible radiation damage and inaccuracy of radiological investigations, particularly in children, ultrasound and superb microvascular imaging (SMI) may offer alternative methods of evaluating new bone formation when limb lengthening is undertaken in paediatric patients. The aim of this study was to assess the use of ultrasound combined with SMI in monitoring new bone formation during limb lengthening in children. Methods. In this retrospective cohort study, ultrasound and radiograph examinations were performed every two weeks in 30 paediatric patients undergoing limb lengthening. Ultrasound was used to monitor new bone formation. The number of vertical vessels and the blood flow resistance index were compared with those from plain radiographs. Results. We categorized the new bone formation into three stages: stage I (early lengthening), in which there was no obvious callus formation on radiographs and ultrasound; stage II (lengthening), in which radiographs showed low-density callus formation with uneven distribution and three sub-stages could be identified on ultrasound: in Ia punctate callus was visible; in IIb there was linear callus formation which was not yet connected and in IIc there was continuous linear callus. In stage III (healing), the
To assess the initial rise in inflammatory markers in paediatric patients presenting with long bone osteomyelitis and whether this is comparable with that in septic arthritis, and diagnostic. All radiologically confirmed cases of long bone osteomyelitis without septic arthritis, joint effusion or abscess, in paediatric patients, presenting to one hospital over an eighteen-month period were included. These patients were compared with all culture positive septic arthritides presenting to the same hospital within the same period. Inflammatory markers taken on the day of admission were studied.Purpose
Methods
Aims. Temporary hemiepiphysiodesis (HED) is applied to children and adolescents to correct angular deformities (ADs) in long