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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXIV | Pages 7 - 7
1 May 2012
Gillani S Humphrey J Barry M
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Purpose. A review of the role of external fixators in paediatric trauma at The Royal London Hospital Trauma and Orthopaedic Department. Methods. Retrospective study between 2004 and 2010 reviewing traumatic bone injuries that required initial management with an external fixator. Information was collected through the patients' medical documents and radiographs. Results. In total twenty-seven patients (15 male:12 female, mean age 11, age range 7-15) were initially treated with external fixators over the six year period. The injured bones included 18 tibias, 5 femurs, 2 humeri, 2 radius/ulna, 2 phalanges and 1 wrist. Three patients had two fractures requiring external fixators. Four patients had associated head injuries. Indications included twenty –one open fractures (3 Gustilo type 2, 6 Gustilo type 3A, 12 Gustilo type 3B), seven closed fractures in poly-trauma patients and two closed severely comminuted fractures. Ten fractures were treated with the external fixator as the definitive treatment, fourteen had application of cast following removal of the external fixator and six were converted to internal fixation. Twenty-eight Linear frames were applied (23 Hoffman IIs, 5 Compact Hoffmans) and two circular frames. Mean duration of frame stabilisation was 8 weeks (range 1-16 weeks). Complications included 2 pin site infections successfully treated with antibiotics, 2 patients with hypertrophic scars, 2 leg length discrepancies secondary to bone loss, 2 patients had delayed union and 2 patients had a lower limb deformity requiring intervention, one for adjustment of frame and the other for correction osteotomy with circular frame. Conclusion. The use of external fixators has an important role to play in the management of open fractures and poly-trauma paediatric patients


The Bone & Joint Journal
Vol. 98-B, Issue 12 | Pages 1689 - 1696
1 Dec 2016
Cheung JPY Cheung PWH Samartzis D Cheung KMC Luk KDK

Aims

We report the use of the distal radius and ulna (DRU) classification for the prediction of peak growth (PG) and growth cessation (GC) in 777 patients with idiopathic scoliosis. We compare this classification with other commonly used parameters of maturity.

Patients and Methods

The following data were extracted from the patients’ records and radiographs: chronological age, body height (BH), arm span (AS), date of menarche, Risser sign, DRU grade and status of the phalangeal and metacarpal physes. The mean rates of growth were recorded according to each parameter of maturity. PG was defined as the summit of the curve and GC as the plateau in deceleration of growth. The rates of growth at PG and GC were used for analysis using receiver operating characteristic (ROC) curves to determine the strength and cutoff values of the parameters of growth.


The Bone & Joint Journal
Vol. 97-B, Issue 4 | Pages 442 - 448
1 Apr 2015
Kosuge D Barry M

The management of children’s fractures has evolved as a result of better health education, changes in lifestyle, improved implant technology and the changing expectations of society. This review focuses on the changes seen in paediatric fractures, including epidemiology, the increasing problems of obesity, the mechanisms of injury, non-accidental injuries and litigation. We also examine the changes in the management of fractures at three specific sites: the supracondylar humerus, femoral shaft and forearm. There has been an increasing trend towards surgical stabilisation of these fractures. The reasons for this are multifactorial, including societal expectations of a perfect result and reduced hospital stay. Reduced hospital stay is beneficial to the social, educational and psychological needs of the child and beneficial to society as a whole, due to reduced costs.

Cite this article: Bone Joint J 2015; 97-B:442–8.