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Medicina
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Advanced Trauma Operative Management (ATOM) in Children
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Advanced Trauma Operative Management (ATOM) in Children

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Pediatrics".

Deadline for manuscript submissions: closed (25 February 2023) | Viewed by 13504

Special Issue Editor

Prof. Dr. Federico Canavese

E-Mail Website
Guest Editor
Department of Pediatric Orthopedic Surgery, Jeanne de Flandre Hospital, Lille University Centre, 59800 Lille, France
Interests: pediatric orthopedics; pediatric trauma; hip pediatric surgery; spine pediatric surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

During the past two decades or so, dramatic demographic and socio-cultural modifications have influenced the epidemiology of pediatric fractures. The appearance of new leisure devices such as overboard, electric scooter, trampoline or monkey bars have led to a further evolution in the daily practices of the paediatric population with a change in possible traumatic mechanisms. At the same time, management options have evolved due to improved surgical knowledge and technical advances. In particular, the appearance of new operating techniques (Elastic Stable Intramedullary Nailing, for example), as well as the use of new materials (bio-absorbable materials, for example) are revolutionizing the treatment of pediatric fractures even though the best therapeutic options are still debated.

This Special Issue will share the experience of world-leading pediatric orthopedic surgeons through original research articles, formal systematic literature reviews, and case presentations; its purpose is to is to improve the scientific understanding of pediatric fractures, as well as to outline the diagnostic and surgical strategies, the choice of implants and the outcome of such injuries. 

Authors are welcomed to submit manuscripts on specific pediatric fractures that discuss important advancements in management and/or and novel surgical interventions.

I hope this special issue will allow the dissemination of innovative and modern elements related to the management of pediatric fractures, and will underline the progress still to be made to achieve optimal treatment.

Prof. Dr. Federico Canavese
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • children
  • fracture
  • management
  • surgery
  • operative management
  • outcome
  • complications

Published Papers (6 papers)

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Editorial

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2 pages, 231 KiB  
Editorial
Advanced Trauma Operative Management in Children
by Federico Canavese
Medicina 2023, 59(5), 963; https://doi.org/10.3390/medicina59050963 - 16 May 2023
Viewed by 890
Abstract
Fractures in children and adolescents present a diagnostic and therapeutic challenge to the orthopedic surgeon as there are still many uncertainties in the scientific understanding of these injuries [...] Full article
(This article belongs to the Special Issue Advanced Trauma Operative Management (ATOM) in Children)

Research

Jump to: Editorial, Other

10 pages, 1557 KiB  
Article
To Angulate or Not to Angulate the Ulna during the Progressive Distraction Period Performed with a Monolateral External Fixator in Paediatric Patients with a Chronic Monteggia Fracture?
by Yanhan Liu, Hai Zhao, Hongwen Xu, Weizhe Shi, Jingchun Li, Yiqiang Li and Federico Canavese
Medicina 2022, 58(11), 1666; https://doi.org/10.3390/medicina58111666 - 17 Nov 2022
Cited by 4 | Viewed by 1641
Abstract
Background and Objectives: The purpose of this study was to compare the clinical and radiographic evolution of chronic Monteggia fractures (CMFs) treated by ulnar osteotomy and monolateral external fixators (MEFs) with or without angulation of the ulna during the distraction period. Materials and [...] Read more.
Background and Objectives: The purpose of this study was to compare the clinical and radiographic evolution of chronic Monteggia fractures (CMFs) treated by ulnar osteotomy and monolateral external fixators (MEFs) with or without angulation of the ulna during the distraction period. Materials and Methods: This retrospective study evaluated 20 children (14 boys and 6 girls) with CMFs. According to the strategy of ulnar lengthening, two groups of patients were identified: patients undergoing gradual lengthening with (Group A, n = 11) or without ulna angulation (Group B, n = 9). The mean age at the time of surgery was 7.7 years old (range, 5.4–12.9). The mean time from initial trauma to surgery was 26.3 months (range, 1–96), and the mean follow-up was 24.6 months (range, 5.5–45.4). Clinical outcomes were evaluated by Kim et al.’s Elbow Performance Score, while radiographic outcomes were assessed on plain radiographs. Results: Age at surgery, sex, laterality, time between trauma and surgery, and time of follow up in the two groups of patients showed no significant differences. The radial head was successfully reduced in 9 of 9 and 10 of 11 patients in Groups B and A, respectively (p = 1.00). The mean time to achieve radial head reduction was shorter in Group B (18.1 ± 5.3 days) than in Group A (39.2 ± 18.7 days; p = 0.004). The mean angulation of the ulna at the end of treatment was significantly lower in Group B (0.6° ± 1.1°) than in Group A (25.9° ± 6.3°; p < 0.0001). The average ulnar lengthening at the end of treatment in Group B (14.1 ± 5.8 mm) was, on average, 7.7 mm less than that in Group A (21.8 ± 9.7 mm; p = 0.05). The Kim et al. Elbow Performance Score at the last follow-up visit was comparable between the two groups of patients (p = 1.00). Conclusions: A shorter time to achieve radial head reduction and less deformity of the ulna can be expected in paediatric patients with CMFs undergoing intraoperative restoration of ulnar alignment and gradual lengthening without angulation postoperatively. Full article
(This article belongs to the Special Issue Advanced Trauma Operative Management (ATOM) in Children)
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12 pages, 3222 KiB  
Article
Do the Number, Size, and Position of Partially Threaded Screws Affect the Radiological Healing of Surgically Treated Displaced Femoral Neck Fractures? A Review of 136 Children
by Wentao Wang, Zhu Xiong, Chongzhi Zhao, Bo He, Haibo Mei, Yiqiang Li, Federico Canavese, Yuancheng Pan and Shunyou Chen
Medicina 2022, 58(9), 1153; https://doi.org/10.3390/medicina58091153 - 25 Aug 2022
Cited by 4 | Viewed by 2051
Abstract
Background and Objectives: The quantity, size, and position of implants might affect the fracture healing process of surgically treated displaced pediatric femoral neck fractures (PFNFs). The aim of this retrospective multicenter study was to evaluate the correlation between the time needed to achieve [...] Read more.
Background and Objectives: The quantity, size, and position of implants might affect the fracture healing process of surgically treated displaced pediatric femoral neck fractures (PFNFs). The aim of this retrospective multicenter study was to evaluate the correlation between the time needed to achieve radiological union and the number, size, and location of the partially threaded cannulated screws (PTCSs) in children with displaced PFNFs. Materials and Methods: A retrospective review of 136 children (mean age: 10.6 ± 3.8 years) with displaced PFNFs treated by two (n = 103) or three (n = 33) PTCSs was carried out. Student’s t-tests, one-way ANOVA, Cox regression analysis, and multiple linear regression analyses were performed to investigate the variables affecting the time needed to achieve radiological fracture healing according to the number, size, and position of PTCSs, as assessed on plain radiographs. Results: A total of 132 hips achieved union at an average of 3.2 ± 1.6 months after the initial surgery. The time needed to achieve union in the patients treated with two or three PTCSs was comparable (p = 0.36). Among the fractures treated by two PTCSs, the time needed to achieve union did not correlate with the size of the implant (p = 0.122), or with the angulation between the PTCSs on anterior–posterior (p = 0.257) and lateral radiographs (p = 0.547). The time needed to achieve union in the fractures that were fully compressed by the implants was similar to the partially compressed fractures (p = 0.08). Conclusions: The number, size, and position of the PTCSs do not affect the radiological healing in the children with displaced PFNFs treated surgically. Full article
(This article belongs to the Special Issue Advanced Trauma Operative Management (ATOM) in Children)
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10 pages, 2642 KiB  
Article
Is Femoral Neck System a Valid Alternative for the Treatment of Displaced Femoral Neck Fractures in Adolescents? A Comparative Study of Femoral Neck System versus Cannulated Compression Screw
by Yunan Lu, Federico Canavese, Guoxin Nan, Ran Lin, Yuling Huang, Nuoqi Pan and Shunyou Chen
Medicina 2022, 58(8), 999; https://doi.org/10.3390/medicina58080999 - 27 Jul 2022
Cited by 4 | Viewed by 3565
Abstract
Background and Objectives: The femoral neck system (FNS) is a new minimally invasive internal fixation system for femoral neck fractures (FNFs), but its use has not been reported in adolescents. The aim of this study was to compare the clinical and radiographic [...] Read more.
Background and Objectives: The femoral neck system (FNS) is a new minimally invasive internal fixation system for femoral neck fractures (FNFs), but its use has not been reported in adolescents. The aim of this study was to compare the clinical and radiographic outcomes of displaced FNF in adolescents treated with FNS or a cannulated compression screw (CCS). Materials and Methods: A retrospective study of 58 consecutive patients with displaced FNF treated surgically was performed; overall, 28 patients underwent FNS and 30 CCS fixation. Sex, age at injury, type of fracture, associated lesions, duration of surgery, radiation exposure, and blood loss were collected from the hospital database. The clinical and radiographic results, as well as complications, were recorded and compared. Results: The patients were followed up for 16.4 ± 3.1 months on average after index surgery (range, 12 to 24). Consolidation time among patients treated with FNS was significantly lower than those managed by CCS (p = 0.000). The functional scores of patients treated with FNS were significantly higher than those managed by CCS (p = 0.030). Unplanned hardware removal in patients treated with FNS was significantly lower than in those managed by CCS (p = 0.024). Conclusions: FNS has a lower complication rate and better functional outcome than CCS. It may be a good alternative to treat femoral neck fractures in adolescents. Full article
(This article belongs to the Special Issue Advanced Trauma Operative Management (ATOM) in Children)
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8 pages, 535 KiB  
Article
Clinical Characteristics and Distribution of Pediatric Fractures at a Tertiary Hospital in Northern France: A 20-Year-Distance Comparative Analysis (1999–2019)
by Faustine Monget, Marco Sapienza, Kathryn Louise McCracken, Eric Nectoux, Damien Fron, Antonio Andreacchio, Vito Pavone and Federico Canavese
Medicina 2022, 58(5), 610; https://doi.org/10.3390/medicina58050610 - 28 Apr 2022
Cited by 7 | Viewed by 1505
Abstract
Background and objectives: The epidemiology and distribution of pediatric fractures change over time and are influenced by a multitude of factors including geography, climate, and population characteristics. The aims of our work were to study the distribution of traumatic pediatric orthopedic injuries [...] Read more.
Background and objectives: The epidemiology and distribution of pediatric fractures change over time and are influenced by a multitude of factors including geography, climate, and population characteristics. The aims of our work were to study the distribution of traumatic pediatric orthopedic injuries admitted to the Lille University Hospital (LUH) Pediatric Emergency Department in 1999 and in 2019 and to analyze the epidemiological differences 20 years apart. Materials and methods: This was a retrospective, comparative, monocentric, and epidemiological study involving all children between 0 and 15 years and 3 months of age who consulted the pediatric emergencies of LUH from 1 January 1999 to 31 December 1999 and from 1 January 2019 to 31 December 2019. On admission, the following data were collected: sex, age at the time of injury, month and time of the day the trauma occurred (4:00 a.m to 11:59 a.m, 12:00 p.m. to 19:59 p.m, and 20:00 p.m to 3:59 a.m.), mechanism of injury, laterality (right or left), anatomical location, type of injury, and whether the fracture was closed or open. The type of treatment (orthopedic or surgical) was collected from the medical records. Results: A total of 939 children were included in 1999 compared with 781 in 2019 (21% decrease); the average age of children with fractures was significantly higher in 1999 (8.81 years) than in 2019 (7.19 years). This difference was explained by the majority involvement of older children (10–15 years) in 1999 (43% of fractures in 1999 versus 25% of fractures in 2019). Conversely, small children (1–5 years) had significantly more fractures in 2019 (36%) than in 1999 (24%). Conclusions: Overall, the types and sites of fractures did not change over the studied time despite a change in the population and mechanism of injury. This suggested that the reflexes of breaking a fall still tended to implicate and damage the same bone segments. Finally, the proportion of fractures managed surgically versus orthopedically has not evolved since 1999. Exploring this is a possible area of further research that would complement our study. Full article
(This article belongs to the Special Issue Advanced Trauma Operative Management (ATOM) in Children)
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Other

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13 pages, 1235 KiB  
Systematic Review
The Role of Patient Position in the Surgical Treatment of Supracondylar Fractures of the Humerus: Comparison of Prone and Supine Position
by Marco Sapienza, Gianluca Testa, Andrea Vescio, Flora Maria Chiara Panvini, Alessia Caldaci, Stefania Claudia Parisi, Vito Pavone and Federico Canavese
Medicina 2023, 59(2), 374; https://doi.org/10.3390/medicina59020374 - 15 Feb 2023
Cited by 10 | Viewed by 3026
Abstract
Background and Objectives: Supracondylar fractures of the humerus (SCHF) make up about one-third of pediatric fractures and are the most common elbow fractures in children. Reduction and fixation of SC fractures can be performed with the patient in the prone or supine [...] Read more.
Background and Objectives: Supracondylar fractures of the humerus (SCHF) make up about one-third of pediatric fractures and are the most common elbow fractures in children. Reduction and fixation of SC fractures can be performed with the patient in the prone or supine position. However, the role of the patient’s position during surgery is still unclear. The purpose of this systematic review is to evaluate, based on data from the literature, the role of patient position during closed reduction and fixation of pediatric SCHFs. Materials and Methods: A systematic review of the current literature from 1951 to 2021 was conducted according to PRISMA guidelines. Articles were identified from 6 public databases. Articles were screened and abstracted by two investigators and the quality of included publications (n = 14) was assessed (MINORS criteria). Statistical analyses were performed using R studio 4.1.2. Results: The systematic literature review identified 114 articles, from which, according to inclusion and exclusion criteria, 14 studies were identified. A total of 741 children were treated in the prone position and 538 in the supine position. The results of the systematic review showed that there were no statistical differences between the two positions with regard to clinical, radiographic, and complication outcomes. Conclusions:: The functional and radiographic outcome of displaced SCHFs is generally excellent regardless of the position, prone or supine, in which the patient is positioned for surgery. The choice of how to position the patient depends on the habit and experience of the surgeon and anesthesiologist performing the surgery. Full article
(This article belongs to the Special Issue Advanced Trauma Operative Management (ATOM) in Children)
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