Causes of femoral shaft fracture in children under five years of age.

OBJECTIVE: To study the causes of femoral shaft fracture in children younger than 5 years of age. STUDY DESIGN: Retrospective, descriptive study. PATIENTS AND METHOD: Medical records and radiographs of 39 children younger than 5 years of age with femoral shaft fractures treated in Queen Sirikit National Institute of Child Health during the years 1996-2001 were reviewed. The responsible causes for the femoral shaft fracture given by caretakers by interview were collected. RESULTS: The most common history was falling or jumping from a height (36%) followed by traffic accidents (26%) and object or person falling on top of them (23%) respectively. Only one case presented with a history of abuse. Nine cases were suspected of abuse, but, without further investigations it was not possible to identify the exact cause of fracture. CONCLUSION: Histories given by caretakers for the cause of femoral shaft fracture in children younger than 5 years of age are varied. The orthopedists should find out the exact cause of fracture to prevent missed or delayed diagnosis of abuse that may have occurred.

Bilateral asynchronous humeral shaft fractures in a patient with autosomal dominant osteopetrosis type II (Albers-Schonberg disease).

Osteopetrosis is a rare metabolic disease which presents with fragile osteosclerotic bone. A thirteen-year-old girl with an underlying autosomal dominant osteopetrosis (ADO) type II who sustained a left oblique humeral shaft fracture after trivial trauma is presented. Radiographic results showed many characteristic features of osteopetrosis, including incomplete remodeling of a previous fracture of the contralateral humeral shaft. The authors obtained good healing and alignment of the left humeral shaft fracture by sugar tong slab.

Scurvy in pediatric patients: a review of 28 cases.

OBJECTIVE: To study the dietary factors, clinical findings, plasma vitamin C level and post-treatment outcome of scurvy in pediatric patients at Queen Sirikit National Institute of Child Health. STUDY DESIGN: A retrospective study. METHOD: The medical and radiographic records of pediatric patients, diagnosed with scurvy at Queen Sirikit National Institute of Child Health from 1995 to 2002 were reviewed. RESULTS: Twenty-eight pediatric patients were diagnosed with scurvy. Their ages ranged between 10 months-9 years 7 months (median age of 29 months). 93 per cent of the cases were between 1-4 years of age. All were fed with well-cooked foods and small amounts or no vegetables and fruits. Supplementation with ultra heat temperature (UHT) milk was found in 89 per cent, average 5.8 boxes/day and 14.3 months in duration. Eighty-six per cent of cases were misdiagnosed previously. Clinical manifestations involved limp or inability to walk (96%), tenderness of lower limbs (86%), bleeding per gum (36%), fever (18%), and petechial hemorrhage (3.6%). All cases had abnormal radiographic findings compatible with scurvy and 2 cases had epiphyseal separation. All had clinical improvement within the first week after vitamin C supplementation. CONCLUSION: Vitamin C deficiency was found in the children's intake of small amounts or no vegetables and fruits together with UHT-milk. Frequent manifestations were limping and inability to walk and pain in the lower limbs. Response to vitamin C treatment was dramatic.

Physical child abuse of one pediatric tertiary care center.

Objective: To study the demographic characteristic of physical abuse children in one tertiary care center in Thailand. Study design : Retrospective, descriptive study. Materials and Methods: Demographic data and character of injury/injuries of 23 children with diagnosis of physical abuse treated at Queen Sirikit National Institute of Child Health during the year 1995-1999 were analysed. Results: There are an increasing number of physically abused children during the years 1997-1999. The average was 24 months. Two-thirds of the cases were female. Two-thirds were younger than 3 years of age. Two-thirds of children younger than 3 years of age faced with major type of injury. Children from birth to 3 year of age were maximally abused in terms of number and severity. Skin lesions were the most common findings followed by musculoskeletal injury, head injury, abdominal injury and intentional poisoning respectively. One half of the cases were abused by their parents or step-parents. Nearly half of them were still living with the perpetrator. Conclusion: The new medical recording system will improve recording and therefore improve the care given to injured patients.