Johannes Schalamon

Analysis of dog bites in children who are younger than 17 years

OBJECTIVES. This study focuses on the pattern of incidence, mechanisms, and circumstances of accident and injury in a series of pediatric patients who sustained dog bites. METHODS. In our retrospective survey, the medical charts of all children who were younger than 17 years and sought medical attention after a dog bite between 1994 and 2003 were reviewed. To obtain the total number of each dog breed in the administrative district, we analyzed 5873 files from the community dog registers. For establishment of a risk index, the representation of a dog breed among the total canine population was divided by the frequency of dog bites from this breed. RESULTS. A total of 341 children (mean age: 5.9 years) were identified. The annual incidence of dog bites was 0.5 per 1000 children between 0 and 16 years of age. Incidence was highest in 1-year-old patients and decreased with increasing age. The relative risk for a dog attack by a German shepherd or a Doberman was ∼5 times higher than that of a Labrador/retriever or cross-breed. The vast majority (82%) of the dogs were familiar to the children. Most (322; 94%) of the children had injuries to 1 body region; in the remaining 19 (6%) children, up to 3 body regions were injured. Of 357 injuries, the face, head, and neck region was the leading site affected (50%). Inpatient treatment was required in 93 (27%) patients. CONCLUSIONS. Dog bites in children are frequent and influenced by the breed-related behavior of dogs, dog owners, children, and parents. Therefore, prevention strategies should focus on public education and training of dogs and their owners. Children who are younger than 10 years represent the high-risk group for dog attacks.

Multiple trauma in pediatric patients.

Abstract.We analyzed the causes and diagnoses, the treatment, short and long-term outcome of a consecutive series of 70 pediatric polytrauma patients. From 1989 to 1996, 70 children (aged 10 months to 16 years, mean 7.4 years) presented with multiple trauma. A follow-up investigation was performed 4.2 years (mean) after the accident. Traffic accidents (68%) were the leading cause of injuries. Among all injuries (mean ISS 24.6 range 17–57), injuries of the head/neck area were most frequent (87%) followed by extremity fractures (76%) and 135 operations were performed on 55 children, mostly for fracture stabilisation. All multiple injured children survived. At discharge 25 children were still impaired (36% of 70). At follow-up 58 patients were revisited, 11 (19% of 58) presented with impairments, 8 of those (73% of 11) following severe head trauma. This study showed a 10% rate of late impairment due to the severity of the primary head trauma.

Experience with gastro-intestinal duplications in childhood.

Abstract. Background: Intestinal duplications are rare congenital malformations. The different locations and sizes of these duplications require a specific diagnostic and surgical approach. This study reviews our paediatric patients with intestinal duplications in order to analyse the influence of prenatal sonography and laparoscopy on the clinical course. Patients and methods: Thirteen duplications of the alimentary tract in 12 patients have been treated over a 10-year period from 1989 to 1999. Six of our patients were diagnosed prenatally by ultrasound and were free of symptoms until surgery, except for one patient who had meconium-ileus owing to cystic fibrosis. In another five patients, the diagnosis was made on the basis of symptoms with signs of obstruction. In one child, the duplication was found incidentally during an operation for an anorectal malformation. The location of the 13 duplications was the stomach in three cases, the duodenum in one case, the jejunum in two cases, the ileum in six cases and the rectum in one case. Laparotomy was performed in ten patients. Two cases were treated by laparoscopic-assisted resection. Conclusion: Early diagnosis and treatment of uncomplicated intestinal duplications by means of prenatal sonographic screening and laparoscopic-assisted resection, respectively, are desirable in this congenital malformation. Resection of the duplication with or without minimal resection of the adjacent normal intestine should be mandatory.

Quantitative Ultrasound Assessment in Children With Fractures

BMD of children with fractures was compared with healthy controls using QUS. We found significantly lower SOS values in children suffering from fractures. None of the studied environmental factors could explain the difference in BMD measurements.

A study of metatarsal fractures in children

BACKGROUND Metatarsal fractures are common in children. The aim of the present study was to analyze a consecutive series of metatarsal fractures in children and to describe the epidemiology of the fractures, the location of the fractures, and the mechanism of injury. METHODS A consecutive series of 125 patients with metatarsal fractures who presented to one pediatric surgery department over a twenty-two-month period was evaluated with use of a questionnaire to define the mechanism of injury. All patients were followed until the fracture was healed. The specific location of the fractures and the mechanism of injury were identified. RESULTS One hundred and twenty-five children (seventy-five boys and fifty girls; average age, 8.6 years [range, one to seventeen years]) presented with 166 metatarsal fractures. Major differences were found between children who were five years of age or less and those who were more than five years of age. In patients who were five years of age or less, the predominant location of the accident that had caused the fracture was inside the house and the primary mechanism was a fall from a height. In patients who were more than five years of age, most accidents occurred at sports facilities and were caused by a fall on a level surface. The most frequently fractured metatarsal in younger children was the first, whereas the most frequently fractured metatarsal in older children was the fifth. CONCLUSIONS The mechanism of injury and clinical presentation of metatarsal fractures in children are age-dependent, with patients five years of age or less and those more than five years of age having different mechanisms of injury and different types of metatarsal fractures.

ESIN in Forearm Fractures

Background and Purpose:Elastic stable intramedullary nailing (ESIN) is well established for stabilizing pediatric forearm fractures. To prevent uncritical use, it is necessary to evaluate the problems and complications of this common technique.Patients and Methods:Four pediatric surgical departments participated in a retrospective study analyzing the last 400 fractures treated with ESIN. Continuous documentation of treatment, postoperative course and follow-up formed the basis of evaluation. In this article forearm fractures (n = 163, 40.7%) are discussed, and epidemiology, indication, fracture types, intraoperative technique, postoperative management and problems, as well as complications and results are compared to those described in the literature.Results:Complete, transverse fractures of the midshaft (73%) were mainly seen. Indication for intervention was an intolerable axial deviation (85.9%). Intraoperative technique (operating and transillumination time, site of approach, material choice) and postoperative management (hospital stay, number of X-ray controls, and follow-up) differed highly depending on the hospital’s circumstances. Postoperatively, 3.0% of patients showed soft-tissue irritation due to sharp nail ends or wound infections. Complications (10.4%) included secondary rupture of a tendon in 3.7%, refracture with nails in situ in 2.5%, axial deviations > 10° or instability of osteosynthesis in 1.8%, delayed healing in 1.2%, migration of nails in 0.6%, and technical failure in 0.6%. Overall, a significant functional restriction (limitation of movement > 10°) was found in three cases only (1.8%) following radial neck fracture.Conclusion:ESIN in pediatric forearm fractures is an often used technique with clear indications and excellent results to be expected. Numerically, complications have not altered considerably, but they rather show a shifting of problems with optimization and refinement of technique and improvement of equipment. Thus, continuous evaluation of technical principles and procedural recommendations constitutes the mainstay in the prevention of problems and complications.

Fractures of the talus--differences between children and adolescents.

BACKGROUND Fractures of the talus represent serious injuries of the foot skeleton. The most significant complications include osteonecrosis and posttraumatic malalignment with subsequent arthritis. The aim of our study was to compare treatment and outcome of fractures of the talus between children and adolescents. METHODS From 1990 to 2005, 24 patients (18 male, 6 female) presented with 25 fractures of the talus. The medical records were reviewed retrospectively. Follow-up was performed by radiographical grading, and the functional outcome was measured using the Foot-Function-Index. RESULTS Nine patients were 12 years of age or younger, and 15 patients presenting 16 talar fractures were older than 12 years. Although most fractures of the talus in children younger than 12 years were classified as Marti-Weber type I and II fractures, more than two thirds of the fractures in patients older than 12 years were Marti-Weber type III and IV fractures. Two thirds of the patients younger than 12 years were treated nonoperatively, whereas nonoperative treatment was possible in only three talar fractures in adolescents. No necrosis at follow-up (mean period, 3.2 years; range, 7 months to 8.4 years after end of treatment) was detected in children (<12a), whereas five patients older than 12 years developed persisting necrosis. CONCLUSION Even though there is no apparent difference in the cause of the trauma leading to fractures of the talus, adolescents present with more severe fractures of the talus compared with children younger than 12 years. In addition, we did not observe persistent osteonecrosis in patients younger than 12 years old, and the outcome is favorable in most cases irrespective of the mode of treatment.

Evaluation of fractures in children and adolescents in a Level I Trauma Center in Austria.

BACKGROUND Injury represents a major concern for children and adolescents worldwide. It is estimated that 10% to 25% of all pediatric injuries will result in fractures. This study aimed to analyze the epidemiology, gender distribution, age, and circumstances of fractures in childhood in a Level I Trauma Center in Austria. METHODS Children managed with fractures between December 2004 and October 2006 were prospectively evaluated. Patients were divided into four age groups: infants (<1 year), preschool children (1-6 years), school-aged children (6-14 years), and adolescents (>14 years). RESULTS The study included 3,339 patients younger than 19 years, who presented with 3,421 fractures. There was a male predominance (61.3%, n = 2,096). Girls (38.7%, n = 1,325) had a lower mean age at presentation of 8.2 years (boys, 9.8 years). An increase in the incidences of fractures was observed until a peak of 11 years in girls and 12 years in boys. A majority of fractures occurred in sports facilities (34.7%), followed by those at home (17.6%) and outdoors (16.7%). The most frequent mechanisms were falls on level surface (41.9%), falls from a height <3 m (23.2%), and involuntary contact with persons or objects (18.2%). The most common fractures were those of the distal radius (15.3%), followed by those of the finger (14%) and distal forearm fractures (8%). CONCLUSION As the Department of Pediatric Surgery in Graz serves as the referral center at least for nearly all major pediatric fractures in the Austrian state of Styria, mechanisms and patterns of major fractures in this study can serve as the basis for state-wide pediatric injury prevention efforts. These prevention strategies should not aim to reduce the level of exposure but should increase the risk awareness and encourage children and their parents to use necessary precautions.

Galeazzi Lesions in Children and Adolescents: Treatment and Outcome

A Galeazzi fracture is defined as a fracture of the radius associated with dislocation of the distal radioulnar joint. Treatment in children and adolescents is usually possible with closed reduction and casting. The objective of this retrospectively designed study was to describe all Galeazzi lesions treated at our department during a 3-year period. One hundred ninety-eight patients with displaced fractures of the radius alone or both bones of the forearm were reviewed. In 26 (13%) cases, a Galeazzi lesion was found and these patients formed the study group. Outcome was assessed using the Gartland-Werley score. Eight of 26 (31%) fractures were recognized initially and classified as a Galeazzi lesion. Casting after fracture reduction was possible in 22 patients. Thirteen patients were treated with immobilization in a below-elbow cast and nine with an above-elbow cast. Four patients were treated operatively. The results were excellent in 23 cases and good in three cases. In cases of distal forearm fractures, a possible Galeazzi lesion should be considered. However, proper reduction of the radius with concomitant reduction of the distal radioulnar joint and cast immobilization provides good to excellent outcome even if the Galeazzi lesion is primarily not recognized.Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Single-port appendectomy in obese children: an optimal alternative?

Introduction:  The aim of this study was to evaluate our experience with single‐port appendectomy (SPA) in obese children.